=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053507970
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREGORY D. BOROWSKI, D.P.M.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2007
-----------------------------------------------------
Last Update Date | 09/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6451 FARMDALE RD
-----------------------------------------------------
City | BARBOURSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25504-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-736-0555
-----------------------------------------------------
Fax | 304-736-0556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 628 6451 FARMDALE ROAD
-----------------------------------------------------
City | BARBOURSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25504-0628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-736-0555
-----------------------------------------------------
Fax | 304-736-0556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR/OWNER
-----------------------------------------------------
Name | DR. GREGORY D BOROWSKI
-----------------------------------------------------
Credential | D.P.M.
-----------------------------------------------------
Telephone | 304-736-0555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 00268
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------