Provider Demographics
NPI:1982060919
Name:BERNICE BOROW LLC
Entity Type:Organization
Organization Name:BERNICE BOROW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOROW
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:914-588-7714
Mailing Address - Street 1:7062 KINGSMILL CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5193
Mailing Address - Country:US
Mailing Address - Phone:914-682-1735
Mailing Address - Fax:914-686-5228
Practice Address - Street 1:7062 KINGSMILL CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5193
Practice Address - Country:US
Practice Address - Phone:914-682-1735
Practice Address - Fax:914-686-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 5917133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty