Provider Demographics
NPI:1629015342
Name:BORJA, SUSAN VALDES (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:VALDES
Last Name:BORJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:V
Other - Last Name:BORJA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:316 LENOX AVE
Mailing Address - Street 2:2A
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-5113
Mailing Address - Country:US
Mailing Address - Phone:908-233-7903
Mailing Address - Fax:908-233-7905
Practice Address - Street 1:316 LENOX AVE
Practice Address - Street 2:2A
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-5113
Practice Address - Country:US
Practice Address - Phone:908-233-7903
Practice Address - Fax:908-233-7905
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA536852084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3918807Medicaid
E27328Medicare UPIN