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General NPI Number Information
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NPI Number | 1598807992
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Entity Type | Individual
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Provider Name | MARK B BORG JR. PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 08/01/2012
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Provider Practice Location Address
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Address Line | 1133 BROADWAY SUITE 920
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City | NEW YORK
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State | NY
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Zip | 10010-8218
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Country | US
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Telephone | 212-978-0266
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Fax | 212-741-1697
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Provider Business Mailing Address
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Address Line | 1133 BROADWAY SUITE 920
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City | NEW YORK
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State | NY
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Zip | 10010-8218
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Country | US
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Telephone | 212-978-0266
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Fax | 212-741-1697
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 013891
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013891
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License Number State | NY
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