MEDICARE: DR. GREGORY BORUKHOV OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WV0400X	Vision Therapy Optometrist	TUV008172-1	NY

General Provider Information

NPI Number	:	1033524301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY BORUKHOV OD

Provider Business Mailing Address
First Line	:	4600 9TH AVE APT 511
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1448 86TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3429
Country	:	US
Telephone Number	:	718-265-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2014
Last Update Date	:	11/09/2015

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