Healthcare Provider Details

I. General information

NPI: 1306761937
Provider Name (Legal Business Name): BAHAR BORCIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 HARVEST AVE
STATEN ISLAND NY
10310-2927
US

IV. Provider business mailing address

111 HARVEST AVE
STATEN ISLAND NY
10310-2927
US

V. Phone/Fax

Practice location:
  • Phone: 929-304-0174
  • Fax:
Mailing address:
  • Phone: 929-304-0174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number601495570
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: