Provider Demographics
NPI:1154363539
Name:BORNER, IRMGARD (MD)
Entity type:Individual
Prefix:
First Name:IRMGARD
Middle Name:
Last Name:BORNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 LINCOLN PLACE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217
Mailing Address - Country:US
Mailing Address - Phone:718-857-1733
Mailing Address - Fax:718-638-0610
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:12CHC BROOKDALE UNIV HOSP AND MED CTR DEPT OF PSYCHIATR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-8303
Practice Address - Fax:718-240-8164
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1304172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00974245Medicaid
NY56A022Medicare UPIN
B16452Medicare UPIN