Healthcare Provider Details

I. General information

NPI: 1245260330
Provider Name (Legal Business Name): LYNN BORZILLO D.A., L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

565 LONG HILL RD
GROTON CT
06340-4166
US

IV. Provider business mailing address

11 DUCHESS DR
OLD LYME CT
06371-1357
US

V. Phone/Fax

Practice location:
  • Phone: 860-448-2225
  • Fax: 860-322-0061
Mailing address:
  • Phone: 860-227-0079
  • Fax: 860-322-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000335
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: