Provider Demographics
NPI:1104468198
Name:BORST, DAVID LEONARD (OTR/L, MS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEONARD
Last Name:BORST
Suffix:
Gender:M
Credentials:OTR/L, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 APAWAMIS AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3601
Mailing Address - Country:US
Mailing Address - Phone:201-394-9936
Mailing Address - Fax:
Practice Address - Street 1:2255 COLEMAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5126
Practice Address - Country:US
Practice Address - Phone:718-434-5100
Practice Address - Fax:718-256-1245
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00829100225X00000X
NY024390-01225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist