Provider Demographics
NPI:1114237351
Name:ROGER BORCHARDT, MD, LLC
Entity Type:Organization
Organization Name:ROGER BORCHARDT, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:BORCHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-679-2470
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-0648
Mailing Address - Country:US
Mailing Address - Phone:201-679-2470
Mailing Address - Fax:201-300-4384
Practice Address - Street 1:88 BROWNSTONE WAY
Practice Address - Street 2:#107
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1201
Practice Address - Country:US
Practice Address - Phone:201-679-2470
Practice Address - Fax:201-300-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08749100207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty