Provider Demographics
NPI:1952626889
Name:BORODANSKI, ZOYA
Entity Type:Individual
Prefix:
First Name:ZOYA
Middle Name:
Last Name:BORODANSKI
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 1:1101 BRIGHTON BEACH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-5558
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1101 BRIGHTON BEACH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-5558
Practice Address - Country:US
Practice Address - Phone:718-891-2801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-04
Last Update Date:2010-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046754-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist