Provider Demographics
NPI:1902839079
Name:LAURENT, BORDES P (MD)
Entity Type:Individual
Prefix:DR
First Name:BORDES
Middle Name:P
Last Name:LAURENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 E 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-3162
Mailing Address - Country:US
Mailing Address - Phone:718-940-0653
Mailing Address - Fax:718-940-7400
Practice Address - Street 1:716 E 32ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3162
Practice Address - Country:US
Practice Address - Phone:718-940-0653
Practice Address - Fax:718-940-7400
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2014-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1975032084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG23454Medicare UPIN