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General NPI Number Information
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NPI Number | 1548791569
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Entity Type | Individual
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Provider Name | MICHAEL BORRERO
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Gender | Male
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Dates
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Enumeration Date | 03/22/2017
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 70 N COUNTRY RD
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City | PORT JEFFERSON
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State | NY
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Zip | 11777-2161
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Country | US
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Telephone | 631-357-5024
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Fax | 631-509-0968
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Provider Business Mailing Address
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Address Line | 8 PARISH CT
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City | STONY BROOK
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State | NY
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Zip | 11790-2613
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Country | US
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Telephone | 631-252-1409
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 328396
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License Number State | NY
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