Provider Demographics
NPI:1992080626
Name:BORUKHOV, LEV (DPT)
Entity type:Individual
Prefix:DR
First Name:LEV
Middle Name:
Last Name:BORUKHOV
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 6TH AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-3525
Mailing Address - Country:US
Mailing Address - Phone:718-791-9423
Mailing Address - Fax:
Practice Address - Street 1:1 W 30TH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4424
Practice Address - Country:US
Practice Address - Phone:718-791-9423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033914225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist