Individual
LISA BORDUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2904 ROUTE 6, SLATE HILL, NY 10973-3810
(845) 355-4611
(845) 355-2776
Mailing address
158 N MAIN ST, PO BOX 299, FLORIDA, NY 10921-1133
(845) 651-1412
(845) 651-1510
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009221
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1056042
NCCPA
—
01
—
25MP00104200
PA MEDICAL LICENSE
NJ
Enumeration date
07/09/2006
Last updated
07/08/2007
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