Provider Demographics
NPI:1972583623
Name:BORDINI, ERNEST J
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:J
Last Name:BORDINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 NW 40TH TER
Mailing Address - Street 2:STE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-3570
Mailing Address - Country:US
Mailing Address - Phone:352-336-2888
Mailing Address - Fax:352-371-1730
Practice Address - Street 1:2121 NW 40TH TER
Practice Address - Street 2:STE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-3570
Practice Address - Country:US
Practice Address - Phone:352-336-2888
Practice Address - Fax:352-371-1730
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73441OtherBCBS
FL73441YMedicare ID - Type Unspecified
NPP000Medicare UPIN