Provider Demographics
NPI:1184671885
Name:BORIS, WALTER (DO)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:BORIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ROUTE 70 E STE C
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1855
Mailing Address - Country:US
Mailing Address - Phone:856-355-7176
Mailing Address - Fax:856-762-1249
Practice Address - Street 1:141 ROUTE 70 E STE C
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1855
Practice Address - Country:US
Practice Address - Phone:856-355-7176
Practice Address - Fax:856-762-1249
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05420700208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ476391BVPMedicare ID - Type Unspecified
NJC34538Medicare UPIN