Provider Demographics
NPI:1053324582
Name:JOSEPH I BORDEN DPM INC
Entity Type:Organization
Organization Name:JOSEPH I BORDEN DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:IRVING
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-342-6109
Mailing Address - Street 1:19231 VICTORY BLVD
Mailing Address - Street 2:# 204
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6331
Mailing Address - Country:US
Mailing Address - Phone:818-342-6109
Mailing Address - Fax:818-342-4825
Practice Address - Street 1:19231 VICTORY BLVD
Practice Address - Street 2:# 204
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6331
Practice Address - Country:US
Practice Address - Phone:818-342-6109
Practice Address - Fax:818-342-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1970213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19701Medicaid
CAWE1970AOtherMEDICARE PIN
CA000E19701Medicaid
CAT19154Medicare UPIN
CAE1970AMedicare ID - Type UnspecifiedMEDICARE
CA4033250001Medicare NSC