MEDICARE: DR. JACK BORENSTEIN

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	103T00000X	Psychologist	027721	NY
2	103TC0700X	Clinical Psychologist	PY12629	FL

General Provider Information

NPI Number	:	1477106045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACK BORENSTEIN

Provider Business Mailing Address
First Line	:	5420 N 37TH ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2203
Country	:	US
Telephone Number	:	954-399-0120
Fax Number	:

Provider Business Practice Location Address
First Line	:	5420 N 37TH ST
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2203
Country	:	US
Telephone Number	:	954-399-0120
Fax Number	:

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

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	12/09/2025

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Directions to “ DR. JACK BORENSTEIN ” Practice Location

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