Provider Demographics
NPI:1942699921
Name:JEFFREY S BORER PHYSICIAN,P.C.
Entity Type:Organization
Organization Name:JEFFREY S BORER PHYSICIAN,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-831-4444
Mailing Address - Street 1:47 E 88TH ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1152
Mailing Address - Country:US
Mailing Address - Phone:212-831-4444
Mailing Address - Fax:212-249-6856
Practice Address - Street 1:635 MADISON AVE
Practice Address - Street 2:3RD FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1009
Practice Address - Country:US
Practice Address - Phone:212-289-7777
Practice Address - Fax:212-249-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112183207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00572110Medicaid
NY00572110Medicaid