US Army

Primary specialty

Substance Use Disorder Rehabilitation Hospital UnitTaxonomy code 276400000X

License

ICAADC 952 Issued in ID

Legal business name

US ARMY

Practice address

11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438

Phone

(315) 772-8801

Fax

(315) 772-4097

NPI assigned

Nov 8, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Charles Borg, PH.D.

Title

Psychologist

Phone

(315) 772-8801

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1992786859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-8801",
            "fax_number": "315-772-4097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11050 MOUNT BELVEDERE BLVD",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "136025438",
            "telephone_number": "315-772-8801",
            "fax_number": "315-772-4097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "US ARMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BORG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "CHARLES",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "315-772-8801",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "276400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation, Substance Use Disorder Unit",
            "state": "ID",
            "license": "ICAADC 952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Substance Use Disorder Rehabilitation Hospital Unit in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Substance Use Disorder Rehabilitation Hospital Unit in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.