Healthcare Provider Details

I. General information

NPI: 1649698325
Provider Name (Legal Business Name): RACHEL BORLACK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WAYNE AVE FL 7
BRONX NY
10467-2552
US

IV. Provider business mailing address

3411 WAYNE AVE FL 7
BRONX NY
10467-2552
US

V. Phone/Fax

Practice location:
  • Phone: 717-741-2332
  • Fax:
Mailing address:
  • Phone: 718-741-2332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number281951
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: