Provider Demographics
NPI:1508456898
Name:BORGATTA, MIA (IBCLC, RN, LMT, CD)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:BORGATTA
Suffix:
Gender:F
Credentials:IBCLC, RN, LMT, CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 E 2ND ST # 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1020
Mailing Address - Country:US
Mailing Address - Phone:917-407-6840
Mailing Address - Fax:
Practice Address - Street 1:2 E 2ND ST # 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1020
Practice Address - Country:US
Practice Address - Phone:917-407-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY630799163W00000X
NY003538225700000X
NY374J00000X
NY302643163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374J00000XNursing Service Related ProvidersDoula