Provider Demographics
NPI:1891896304
Name:BORIS, ADAM JAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:JAY
Last Name:BORIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-5949
Mailing Address - Country:US
Mailing Address - Phone:212-697-4690
Mailing Address - Fax:212-983-8395
Practice Address - Street 1:304 E 41ST ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-5949
Practice Address - Country:US
Practice Address - Phone:212-697-4690
Practice Address - Fax:212-983-8395
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040892122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist