Individual
TED BORKSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CASAC
Contact information
Practice address
44 5TH ST, RONKONKOMA, NY 11779-5346
(631) 413-0597
Mailing address
44 5TH ST, RONKONKOMA, NY 11779-5346
(631) 413-0597
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/20/2011
Last updated
06/20/2011
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