Healthcare Provider Details

I. General information

NPI: 1235166281
Provider Name (Legal Business Name): MARINA BORUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE STE H
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

22 N 6TH ST APT 23GH
BROOKLYN NY
11249-3093
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1638
  • Fax:
Mailing address:
  • Phone: 646-481-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD41090
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number41282
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number237406
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number237406
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: