Healthcare Provider Details

I. General information

NPI: 1679234108
Provider Name (Legal Business Name): MR. DANIEL P BOROSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2022
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 BELMONT AVE
YOUNGSTOWN OH
44505-2405
US

IV. Provider business mailing address

567 EDWARD LN
CAMPBELL OH
44405-1258
US

V. Phone/Fax

Practice location:
  • Phone: 330-743-1015
  • Fax: 330-743-1025
Mailing address:
  • Phone: 330-787-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2308832
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: