Provider Demographics
NPI:1992841464
Name:BORON, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DAVID
Last Name:BORON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:107 WEST 4TH STREET
Mailing Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550
Mailing Address - Country:US
Mailing Address - Phone:914-699-7200
Mailing Address - Fax:914-699-0837
Practice Address - Street 1:107 WEST 4TH STREET
Practice Address - Street 2:MOUNT VERNON NEIGHBORHOOD HEALTH CENTER
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550
Practice Address - Country:US
Practice Address - Phone:914-699-7200
Practice Address - Fax:914-699-0837
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY199996-1207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01877792Medicaid
NY97T531Medicare ID - Type Unspecified
NYG79472Medicare UPIN