MEDICARE: INGER MELISSA BORGEN-ROVITZ

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	225X00000X	Occupational Therapist	004208-1	NY

General Provider Information

NPI Number	:	1902164940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGER MELISSA BORGEN-ROVITZ

Provider Business Mailing Address
First Line	:	3045 42ND ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11103-3035
Country	:	US
Telephone Number	:	718-728-4646
Fax Number	:

Provider Business Practice Location Address
First Line	:	3045 42ND ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11103-3035
Country	:	US
Telephone Number	:	718-728-4646
Fax Number	:

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

Provider Enumeration Date	:	04/27/2012
Last Update Date	:	04/27/2012

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