Provider Demographics
NPI:1457595225
Name:BORUKHOVA, SOFIYA (OTA)
Entity Type:Individual
Prefix:
First Name:SOFIYA
Middle Name:
Last Name:BORUKHOVA
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9941 64TH AVE APT D16
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2610
Mailing Address - Country:US
Mailing Address - Phone:646-258-5295
Mailing Address - Fax:718-275-1029
Practice Address - Street 1:9941 64TH AVE APT D16
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2610
Practice Address - Country:US
Practice Address - Phone:646-258-5295
Practice Address - Fax:718-275-1029
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006759224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant