Provider Demographics
NPI:1235341504
Name:BORNSTEIN, WAYNE (COTA)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:
Last Name:BORNSTEIN
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4703 MCKINNEY AVE
Mailing Address - Street 2:'A'
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75205-5571
Mailing Address - Country:US
Mailing Address - Phone:972-955-5955
Mailing Address - Fax:
Practice Address - Street 1:9011 JOHN W CARPENTER FWY
Practice Address - Street 2:101
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4525
Practice Address - Country:US
Practice Address - Phone:214-699-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209067174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist