Provider Demographics
NPI:1619165156
Name:BORN, TREVOR MASON (MD)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:MASON
Last Name:BORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4155
Mailing Address - Country:US
Mailing Address - Phone:212-400-0999
Mailing Address - Fax:212-400-0991
Practice Address - Street 1:910 5TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4155
Practice Address - Country:US
Practice Address - Phone:212-400-0999
Practice Address - Fax:212-400-0991
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243951174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist