Provider Demographics
NPI:1972736494
Name:BORUKHOV, ALLA
Entity Type:Individual
Prefix:MRS
First Name:ALLA
Middle Name:
Last Name:BORUKHOV
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 1:8502 139TH ST APT 4M
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-2652
Mailing Address - Country:US
Mailing Address - Phone:347-475-0165
Mailing Address - Fax:
Practice Address - Street 1:134-11 KEW GARDENS RD.
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-441-0155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-01
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12112964235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist