Individual
DR. LARRY S BORAKOVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
55 OLD NYACK TPKE, SUITE 601, NANUET, NY 10954-2461
(914) 714-5023
(845) 634-0806
Mailing address
75 ZUKOR RD, NEW CITY, NY 10956-5507
(914) 714-5023
(845) 634-0806
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
011044
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02192671
—
NY
Enumeration date
02/15/2007
Last updated
08/30/2010
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