MEDICARE: BORO TEST INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center

General Provider Information

NPI Number	:	1306117148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORO TEST INC

Provider Business Mailing Address
First Line	:	251 E 5TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-2403
Country	:	US
Telephone Number	:	718-338-6300
Fax Number	:	347-710-1969

Provider Business Practice Location Address
First Line	:	2955 CONEY ISLAND AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-5220
Country	:	US
Telephone Number	:	718-338-6300
Fax Number	:	347-710-1969

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARINA RABINOVICH
Credential	:
Telephone Number	:	718-338-6300

Provider Enumeration Date	:	01/25/2012
Last Update Date	:	01/25/2012

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