Provider Demographics
NPI:1114494135
Name:BORGES, KLAYDSON JOSE MARTINS (ACUPUNCTURIST)
Entity Type:Individual
Prefix:MR
First Name:KLAYDSON
Middle Name:JOSE MARTINS
Last Name:BORGES
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2020
Mailing Address - Country:US
Mailing Address - Phone:718-701-4545
Mailing Address - Fax:718-816-5297
Practice Address - Street 1:895 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-2020
Practice Address - Country:US
Practice Address - Phone:718-701-4545
Practice Address - Fax:718-816-5297
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006394-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty