Provider Demographics
NPI:1649448879
Name:BOREESENKO, TETYANA (DPM)
Entity type:Individual
Prefix:DR
First Name:TETYANA
Middle Name:
Last Name:BOREESENKO
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 HEATHER RDG
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-8321
Mailing Address - Country:US
Mailing Address - Phone:516-316-7956
Mailing Address - Fax:718-793-5512
Practice Address - Street 1:29 HEATHER RDG
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-8321
Practice Address - Country:US
Practice Address - Phone:516-316-7956
Practice Address - Fax:718-793-5512
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN006232-01213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist