Provider Demographics
NPI:1811419161
Name:BORYS, JESSE DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:DAVID
Last Name:BORYS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 OREGON PIKE STE 1201
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4375
Mailing Address - Country:US
Mailing Address - Phone:717-393-4503
Mailing Address - Fax:717-393-5524
Practice Address - Street 1:1525 OREGON PIKE STE 1201
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4375
Practice Address - Country:US
Practice Address - Phone:717-393-4503
Practice Address - Fax:717-393-5524
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006870213E00000X, 213EP1101X, 213ES0103X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1037732260001Medicaid