Individual
INGMARIE BORNEBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
17 WOODBINE AVE, STONY BROOK, NY 11790-1533
(631) 675-6509
Mailing address
17 WOODBINE AVE, STONY BROOK, NY 11790-1533
(631) 675-6509
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
004566-1
NY
Other
Enumeration date
08/19/2008
Last updated
08/19/2008
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