Provider Demographics
NPI:1093020281
Name:MARVIN BORIS, M.D. PLLC
Entity Type:Organization
Organization Name:MARVIN BORIS, M.D. PLLC
Other - Org Name:LYMPHEDEMA THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-364-2200
Mailing Address - Street 1:77 FROEHLICH FARM BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2903
Mailing Address - Country:US
Mailing Address - Phone:516-364-2200
Mailing Address - Fax:516-364-1844
Practice Address - Street 1:77 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2903
Practice Address - Country:US
Practice Address - Phone:516-364-2200
Practice Address - Fax:516-364-1844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCO6495Medicare UPIN