Provider Demographics
NPI:1144366568
Name:BORO AUDIOLOGY, INC.
Entity type:Organization
Organization Name:BORO AUDIOLOGY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MA
Authorized Official - Last Name:OYIBORHORO
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, FAAA, FA
Authorized Official - Phone:718-622-3500
Mailing Address - Street 1:207 PROSPECT PARK SW
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1500
Mailing Address - Country:US
Mailing Address - Phone:718-622-3500
Mailing Address - Fax:
Practice Address - Street 1:207 PROSPECT PARK SW
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218
Practice Address - Country:US
Practice Address - Phone:718-622-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332S00000X
NY00959231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY165380OtherELDERPLAN
NY4500089OtherUNITED HEALTHCARE
KS723OtherOXFORD
NY418986POtherHIP
NY01316449Medicaid
NY165380OtherELDERPLAN
NY05961Medicare PIN