Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | ||
Y | 103T00000X | Psychologist |
NPI | 1003163510 |
---|---|
Provider Name | Dr. Nestor Ivan Borrero-Bracero |
First Address | Brooklyn, NY 11215-4942 |
Second Address | New York, NY 10024-4018 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2012 |
Last Update Date | 14/08/2012 |