Healthcare Provider Details

I. General information

NPI: 1366410433
Provider Name (Legal Business Name): STEPHEN DAVID BORCHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 PRESTON AVE
STATEN ISLAND NY
10312
US

IV. Provider business mailing address

54 PRESTON AVE
STATEN ISLAND NY
10312
US

V. Phone/Fax

Practice location:
  • Phone: 718-608-1347
  • Fax: 718-608-1361
Mailing address:
  • Phone: 718-608-1347
  • Fax: 718-608-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number175296
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: