Provider Demographics
NPI:1053507970
Name:GREGORY D. BOROWSKI, D.P.M.
Entity type:Organization
Organization Name:GREGORY D. BOROWSKI, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOROWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:304-736-0555
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:6451 FARMDALE ROAD
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-0628
Mailing Address - Country:US
Mailing Address - Phone:304-736-0555
Mailing Address - Fax:304-736-0556
Practice Address - Street 1:6451 FARMDALE RD
Practice Address - Street 2:
Practice Address - City:BARBOURSVILLE
Practice Address - State:WV
Practice Address - Zip Code:25504-1305
Practice Address - Country:US
Practice Address - Phone:304-736-0555
Practice Address - Fax:304-736-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00268332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVU32725Medicare UPIN