Provider Demographics
NPI:1194714402
Name:BORG & IDE IMAGING, PC
Entity type:Organization
Organization Name:BORG & IDE IMAGING, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:S
Authorized Official - Last Name:COHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-241-6400
Mailing Address - Street 1:2263 S CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2623
Mailing Address - Country:US
Mailing Address - Phone:585-241-6400
Mailing Address - Fax:585-241-6505
Practice Address - Street 1:2263 S CLINTON AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2623
Practice Address - Country:US
Practice Address - Phone:585-241-6400
Practice Address - Fax:585-241-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01820319Medicaid
NY01820319Medicaid