Provider Demographics
NPI:1205819414
Name:BORSUK, YOAV (MD)
Entity Type:Individual
Prefix:
First Name:YOAV
Middle Name:
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 1:167 MADISON AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5430
Mailing Address - Country:US
Mailing Address - Phone:212-979-8880
Mailing Address - Fax:
Practice Address - Street 1:167 MADISON AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5430
Practice Address - Country:US
Practice Address - Phone:212-979-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-22
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02020579Medicaid
H27606Medicare UPIN
NY02020579Medicaid