Provider Demographics
NPI:1013090729
Name:STEPHEN V BORIS MD PC
Entity Type:Organization
Organization Name:STEPHEN V BORIS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:BORIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-698-6666
Mailing Address - Street 1:895 MAMARONECK AVE
Mailing Address - Street 2:
Mailing Address - City:MANARONECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543
Mailing Address - Country:US
Mailing Address - Phone:914-698-6666
Mailing Address - Fax:914-698-6681
Practice Address - Street 1:895 MAMARONECK AVENUE
Practice Address - Street 2:
Practice Address - City:MANARONECK
Practice Address - State:NY
Practice Address - Zip Code:10543
Practice Address - Country:US
Practice Address - Phone:914-698-6666
Practice Address - Fax:914-698-6681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY099770207Q00000X, 208000000X
NY208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00443265Medicaid
C12440Medicare UPIN