Provider Demographics
NPI:1083619084
Name:BORSUK, GREGORY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:MICHAEL
Last Name:BORSUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2825
Mailing Address - Country:US
Mailing Address - Phone:732-349-2992
Mailing Address - Fax:732-349-1026
Practice Address - Street 1:1416 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2825
Practice Address - Country:US
Practice Address - Phone:732-349-2992
Practice Address - Fax:732-349-1026
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02090900174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0087200OtherGHI
01000184900OtherAMERICHOICE
NJ1453106Medicaid
0083789000OtherAMERIHEALTH HMO
145184OtherAMERIHEALTH PPO
1047522OtherHORIZON NJ HEALTH
P391182OtherOXFORD
0462430OtherAETNA
0K1557OtherHEALTHNET
19566OtherAMERIGROUP
0083789000OtherAMERIHEALTH HMO
145184Medicare ID - Type Unspecified