Provider Demographics
NPI:1275639601
Name:BORTON, MIRIAM A (MD PSYCHIATRIST)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:A
Last Name:BORTON
Suffix:
Gender:F
Credentials:MD PSYCHIATRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-5678
Mailing Address - Country:US
Mailing Address - Phone:732-356-5665
Mailing Address - Fax:732-356-0507
Practice Address - Street 1:65 MOUNTAIN BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5678
Practice Address - Country:US
Practice Address - Phone:732-356-5665
Practice Address - Fax:732-356-0507
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA042699002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ521140OtherMEDICARE ID
D06826Medicare UPIN