Provider Demographics
NPI:1336495787
Name:BORUKHOVA, YANA (MASTERS ED)
Entity Type:Individual
Prefix:MS
First Name:YANA
Middle Name:
Last Name:BORUKHOVA
Suffix:
Gender:F
Credentials:MASTERS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 63RD DR APT 604
Mailing Address - Street 2:REGO PARK
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-3816
Mailing Address - Country:US
Mailing Address - Phone:917-407-9902
Mailing Address - Fax:
Practice Address - Street 1:8911 63RD DR APT 604
Practice Address - Street 2:REGO PARK
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3816
Practice Address - Country:US
Practice Address - Phone:917-407-9902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY558286111174400000X
NY558450111174400000X
NY558288111174400000X
NY558287111174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist