Provider Demographics
NPI:1407958457
Name:BOROCHOV, INESSA (DPM)
Entity Type:Individual
Prefix:
First Name:INESSA
Middle Name:
Last Name:BOROCHOV
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 61 99 ST.
Mailing Address - Street 2:SUITE G1
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-896-5953
Mailing Address - Fax:
Practice Address - Street 1:63 61 99 STR
Practice Address - Street 2:SUITE G1
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374
Practice Address - Country:US
Practice Address - Phone:718-896-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004953-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01033Medicare ID - Type Unspecified