Provider Demographics
NPI:1083738793
Name:BORG IMAGING GROUP LLP
Entity Type:Organization
Organization Name:BORG IMAGING GROUP LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:WOPPERER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-271-0401
Mailing Address - Street 1:125 LATTIMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620
Mailing Address - Country:US
Mailing Address - Phone:585-271-0401
Mailing Address - Fax:585-271-2051
Practice Address - Street 1:1401 STONE ROAD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615
Practice Address - Country:US
Practice Address - Phone:585-271-0401
Practice Address - Fax:585-271-2051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00848715Medicaid
NYP0180349590OtherBLUE CHOICE
NYP0180349590OtherBLUE CHOICE