Provider Demographics
NPI:1902164940
Name:BORGEN-ROVITZ, INGER MELISSA
Entity Type:Individual
Prefix:
First Name:INGER
Middle Name:MELISSA
Last Name:BORGEN-ROVITZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 42ND ST
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11103-3035
Mailing Address - Country:US
Mailing Address - Phone:718-728-4646
Mailing Address - Fax:
Practice Address - Street 1:3045 42ND ST
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11103-3035
Practice Address - Country:US
Practice Address - Phone:718-728-4646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004208-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist