Provider Demographics
NPI:1134259328
Name:BORBAS SURGICAL SUPPLY, INC
Entity type:Organization
Organization Name:BORBAS SURGICAL SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:KHODY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:186-767-9917
Mailing Address - Street 1:2034 BATH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4806
Mailing Address - Country:US
Mailing Address - Phone:718-676-7991
Mailing Address - Fax:718-676-7992
Practice Address - Street 1:2034 BATH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5278
Practice Address - Country:US
Practice Address - Phone:718-676-7991
Practice Address - Fax:718-676-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X, 335E00000X
NY1067230332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03494204Medicaid
NY4308780001Medicare ID - Type UnspecifiedPROVIDER ID