Provider Demographics
NPI:1689012288
Name:TATIANA BORINOS DDS PC
Entity Type:Organization
Organization Name:TATIANA BORINOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORINOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-544-0500
Mailing Address - Street 1:4501 BROADWAY APT 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-2463
Mailing Address - Country:US
Mailing Address - Phone:212-544-0500
Mailing Address - Fax:
Practice Address - Street 1:4501 BROADWAY APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-2463
Practice Address - Country:US
Practice Address - Phone:212-544-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048601261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental