Provider Demographics
NPI:1245260330
Name:BORZILLO, LYNN (DA, LAC)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:
Last Name:BORZILLO
Suffix:
Gender:F
Credentials:DA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DUCHESS DR
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1357
Mailing Address - Country:US
Mailing Address - Phone:860-227-0079
Mailing Address - Fax:860-322-0061
Practice Address - Street 1:565 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4166
Practice Address - Country:US
Practice Address - Phone:860-448-2225
Practice Address - Fax:860-322-0061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist