Provider Demographics
NPI:1427106723
Name:BORISOVA, MARGARITA B (LAC, MSTOM, MA)
Entity type:Individual
Prefix:MS
First Name:MARGARITA
Middle Name:B
Last Name:BORISOVA
Suffix:
Gender:F
Credentials:LAC, MSTOM, MA
Other - Prefix:MS
Other - First Name:MARGARITA
Other - Middle Name:B
Other - Last Name:BORISSOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3343 SEDGWICK AVE
Mailing Address - Street 2:STE 2D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-6054
Mailing Address - Country:US
Mailing Address - Phone:917-664-6786
Mailing Address - Fax:914-949-8271
Practice Address - Street 1:5 WALLER AVE
Practice Address - Street 2:STE 101
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-5414
Practice Address - Country:US
Practice Address - Phone:917-664-6786
Practice Address - Fax:914-949-8271
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003121171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist