Provider Demographics
NPI:1144313750
Name:BORENSTEIN, DAVID R (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:BORENSTEIN
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 1:1 IPSWICH AVE
Mailing Address - Street 2:# 104
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-829-1672
Mailing Address - Fax:
Practice Address - Street 1:866 E 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2927
Practice Address - Country:US
Practice Address - Phone:718-758-1560
Practice Address - Fax:718-758-1654
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210699208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000420Medicare PIN
NY070BV1Medicare PIN
NYM53601Medicare UPIN