Provider Demographics
NPI:1043274384
Name:BORDEN, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:BORDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:
Other - Last Name:CERBASI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OFFICE MANAGER
Mailing Address - Street 1:180 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631
Mailing Address - Country:US
Mailing Address - Phone:201-871-1766
Mailing Address - Fax:201-871-1391
Practice Address - Street 1:180 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631
Practice Address - Country:US
Practice Address - Phone:201-871-1766
Practice Address - Fax:201-871-1391
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA03048800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJB0001734BYPMedicare PIN
C63184Medicare UPIN
001734Medicare ID - Type UnspecifiedIND
527874Medicare ID - Type UnspecifiedGRP