Healthcare Provider Details

I. General information

NPI: 1285766766
Provider Name (Legal Business Name): CLAIRE BORNSTEIN P.A.-C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2007
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 REVERE ST
STATEN ISLAND NY
10301-3415
US

IV. Provider business mailing address

908 OAK TREE AVE STE L
SOUTH PLAINFIELD NJ
07080-5134
US

V. Phone/Fax

Practice location:
  • Phone: 718-273-3592
  • Fax: 718-273-3592
Mailing address:
  • Phone: 908-757-6660
  • Fax: 908-757-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00013600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number001801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: