MEDICARE: DR. NATALIE BORUCH PHARM.D.

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	1835P1200X	Pharmacotherapy Pharmacist	49951	NY

General Provider Information

NPI Number	:	1487644761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATALIE BORUCH PHARM.D.

Provider Business Mailing Address
First Line	:	15077 VILLAGE RD
Second Line	:
City	:	JAMAICA
State	:	NY
Zip	:	11432-1018
Country	:	US
Telephone Number	:	718-363-6657
Fax Number	:	718-363-6718

Provider Business Practice Location Address
First Line	:	585 SCHENECTADY AVE
Second Line	:	KATZ 2
City	:	BROOKLYN
State	:	NY
Zip	:	11203-1809
Country	:	US
Telephone Number	:	718-363-6657
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/08/2007

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