Provider Demographics
NPI:1497950968
Name:BORDONARO, JEANNINE ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNINE
Middle Name:ANN
Last Name:BORDONARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1101 ERIE BLVD E
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1144
Mailing Address - Country:US
Mailing Address - Phone:315-471-7634
Mailing Address - Fax:315-471-7726
Practice Address - Street 1:1101 ERIE BLVD E
Practice Address - Street 2:SUITE 214
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1144
Practice Address - Country:US
Practice Address - Phone:315-471-7634
Practice Address - Fax:315-471-7726
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1948042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry