MEDICARE: BORBAS SURGICAL SUPPLY, INC

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	332BX2000X	Oxygen Equipment & Supplies (DME)
2	335E00000X	Prosthetic/Orthotic Supplier
3	332B00000X	Durable Medical Equipment & Medical Supplies	1067230	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134259328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORBAS SURGICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	2034 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4806
Country	:	US
Telephone Number	:	718-676-7991
Fax Number	:	718-676-7992

Provider Business Practice Location Address
First Line	:	2034 BATH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-5278
Country	:	US
Telephone Number	:	718-676-7991
Fax Number	:	718-676-7992

Authorized Official
Title or Position	:	CEO
Name	:	MR. EUGENE KHODY
Credential	:
Telephone Number	:	186-767-9917

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	09/12/2022

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