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General NPI Number Information
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NPI Number | 1235341504
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Entity Type | Individual
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Provider Name | WAYNE BORNSTEIN C.O.T.A
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9011 JOHN W CARPENTER FWY 101
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City | DALLAS
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State | TX
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Zip | 75247-4525
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Country | US
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Telephone | 214-699-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 4703 MCKINNEY AVE 'A'
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City | DALLAS
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State | TX
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Zip | 75205-5571
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Country | US
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Telephone | 972-955-5955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 209067
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License Number State | TX
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