Provider Demographics
NPI:1386356558
Name:BORSHCHEVSKY, ROSTISLAV (OTR/L)
Entity type:Individual
Prefix:
First Name:ROSTISLAV
Middle Name:
Last Name:BORSHCHEVSKY
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 BROWN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-1603
Mailing Address - Country:US
Mailing Address - Phone:718-368-2113
Mailing Address - Fax:
Practice Address - Street 1:2962 BRIGHTON 1ST ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-8007
Practice Address - Country:US
Practice Address - Phone:718-368-2113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027188225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist