Provider Demographics
NPI:1962442210
Name:LIVSHITS, BORIS (MD)
Entity Type:Individual
Prefix:
First Name:BORIS
Middle Name:
Last Name:LIVSHITS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 BROADWAY
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-797-8914
Mailing Address - Fax:201-797-8916
Practice Address - Street 1:278 BROADWAY
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:201-797-8914
Practice Address - Fax:201-797-8916
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA070138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8080313Medicaid
NJ8080305Medicaid
NJ8080305Medicaid
H08320Medicare UPIN
052173Medicare ID - Type Unspecified