Provider Demographics
NPI:1407813249
Name:BORGOS, LAURA SALZANO (MD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:SALZANO
Last Name:BORGOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1676 SUNSET AVE
Mailing Address - Street 2:BREAST CARE CENTER
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-5416
Mailing Address - Country:US
Mailing Address - Phone:315-624-5764
Mailing Address - Fax:315-801-8391
Practice Address - Street 1:1676 SUNSET AVE
Practice Address - Street 2:BREAST CARE CENTER
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5416
Practice Address - Country:US
Practice Address - Phone:315-624-5764
Practice Address - Fax:315-801-8391
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282038208600000X
PAMD420397208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0014079Medicaid
NY04273621Medicaid
NY04273621Medicaid
NYJ400261586Medicare UPIN
NJH73573Medicare UPIN