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General NPI Number Information
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NPI Number | 1750644209
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Entity Type | Individual
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Provider Name | ROBERT ANTHONY BORRUSO ATC, CSCS
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1 FALCON PL
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City | DEER PARK
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State | NY
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Zip | 11729-3205
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Country | US
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Telephone | 631-835-2962
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Fax |
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Provider Business Mailing Address
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Address Line | 285 AVE B
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City | LAKE RONKONKOMA
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State | NY
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Zip | 11779
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Country | US
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Telephone | 631-580-0026
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 001812-1
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License Number State | NY
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