Provider Demographics
NPI:1821269259
Name:JOSEPH L BORKSON MD PC
Entity Type:Organization
Organization Name:JOSEPH L BORKSON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BORKSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-732-8866
Mailing Address - Street 1:1530 LOCUST ST
Mailing Address - Street 2:SUITE L
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4415
Mailing Address - Country:US
Mailing Address - Phone:215-732-8866
Mailing Address - Fax:215-732-8861
Practice Address - Street 1:1530 LOCUST ST
Practice Address - Street 2:SUITE L
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4415
Practice Address - Country:US
Practice Address - Phone:215-732-8866
Practice Address - Fax:215-732-8861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSEPH L BORKSON MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040830L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD040830LOtherPA LIC
PA1264110Medicaid
PA1264110Medicaid
PA155525UXVMedicare UPIN