Provider Demographics
NPI:1144958950
Name:BORGESANO, NICOLE M (LMT)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:M
Last Name:BORGESANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 ARCTIC ST
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-6208
Mailing Address - Country:US
Mailing Address - Phone:516-850-6017
Mailing Address - Fax:
Practice Address - Street 1:855 ARCTIC ST
Practice Address - Street 2:
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-6208
Practice Address - Country:US
Practice Address - Phone:516-850-6017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008362-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist