Basic Information
Provider Information
NPI: 1861438376
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BORCZUK
FirstName: MRINALINI
MiddleName: B
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 316 E 30TH ST FL 2
Address2:  
City: NEW YORK
State: NY
PostalCode: 100168366
CountryCode: US
TelephoneNumber: 2126140039
FaxNumber: 2122539631
Practice Location
Address1: 135 E 37TH ST
Address2:  
City: NEW YORK
State: NY
PostalCode: 100163083
CountryCode: US
TelephoneNumber: 2126777170
FaxNumber: 2126778501
Other Information
ProviderEnumerationDate: 06/22/2006
LastUpdateDate: 05/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207K00000X190899NYY Allopathic & Osteopathic PhysiciansAllergy & Immunology 

No ID Information.


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