Provider Demographics
NPI:1891897591
Name:BORNFRIEND, TODD M (PT)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:M
Last Name:BORNFRIEND
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 SUNRISE HWY
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3745
Mailing Address - Country:US
Mailing Address - Phone:516-922-4700
Mailing Address - Fax:516-536-2621
Practice Address - Street 1:660 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2391
Practice Address - Country:US
Practice Address - Phone:516-730-2222
Practice Address - Fax:516-730-2244
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014267-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQQ8801Medicare ID - Type UnspecifiedPHYSICAL THERAPY