Healthcare Provider Details

I. General information

NPI: 1619012242
Provider Name (Legal Business Name): YULIYA BORUCH CNM, NP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E 40TH ST RM 203
NEW YORK NY
10016
US

IV. Provider business mailing address

18222 TUDOR RD
JAMAICA NY
11432-1510
US

V. Phone/Fax

Practice location:
  • Phone: 877-963-9777
  • Fax: 877-989-6644
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number360473
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00041900
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number001245
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number521535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: