Healthcare Provider Details

I. General information

NPI: 1134259328
Provider Name (Legal Business Name): BORBAS SURGICAL SUPPLY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 BATH AVE
BROOKLYN NY
11214-5278
US

IV. Provider business mailing address

2034 BATH AVE
BROOKLYN NY
11214-4806
US

V. Phone/Fax

Practice location:
  • Phone: 718-676-7991
  • Fax: 718-676-7992
Mailing address:
  • Phone: 718-676-7991
  • Fax: 718-676-7992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number1067230
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. EUGENE KHODY
Title or Position: CEO
Credential:
Phone: 186-767-9917