Provider Demographics
NPI:1417232315
Name:BORLAKOV, MAGAMET RUSLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAGAMET
Middle Name:RUSLAN
Last Name:BORLAKOV
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 7TH AVE FL 12A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5893
Mailing Address - Country:US
Mailing Address - Phone:212-377-6437
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE FL 12A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5893
Practice Address - Country:US
Practice Address - Phone:212-377-6437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022568103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty