Provider Demographics
NPI:1790989788
Name:BORDES, MICHELLE CINE
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:CINE
Last Name:BORDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 DEAN ST
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1715
Mailing Address - Country:US
Mailing Address - Phone:631-630-0664
Mailing Address - Fax:
Practice Address - Street 1:30 GAYNOR AVE
Practice Address - Street 2:
Practice Address - City:NESCONSET
Practice Address - State:NY
Practice Address - Zip Code:11767-1828
Practice Address - Country:US
Practice Address - Phone:631-265-4291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216749-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02123233Medicaid