Provider Demographics
NPI:1023361698
Name:BORIUSHKIN, EVGENII
Entity Type:Individual
Prefix:
First Name:EVGENII
Middle Name:
Last Name:BORIUSHKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2032 NW 26TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-1224
Mailing Address - Country:US
Mailing Address - Phone:405-589-8960
Mailing Address - Fax:
Practice Address - Street 1:2032 NW 26TH ST APT 7
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-1224
Practice Address - Country:US
Practice Address - Phone:405-589-8960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other