Provider Demographics
NPI:1598190357
Name:BORG, DAMON ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAMON
Middle Name:ANDREW
Last Name:BORG
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 1:728 LARKFIELD RD
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-6108
Mailing Address - Country:US
Mailing Address - Phone:631-923-0166
Mailing Address - Fax:631-923-0171
Practice Address - Street 1:728 LARKFIELD RD
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-6108
Practice Address - Country:US
Practice Address - Phone:631-923-0166
Practice Address - Fax:631-923-0171
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory