Provider Demographics
NPI:1740502731
Name:STANLEY D BORISH MD INC PS
Entity type:Organization
Organization Name:STANLEY D BORISH MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, CEO
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:BORISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-774-1685
Mailing Address - Street 1:19526 64TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5100
Mailing Address - Country:US
Mailing Address - Phone:425-774-1685
Mailing Address - Fax:425-670-0713
Practice Address - Street 1:19526 64TH AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5100
Practice Address - Country:US
Practice Address - Phone:425-774-1685
Practice Address - Fax:425-670-0713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015305261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAR59249OtherREGENCE BLUE SHIELD
WA1022177Medicaid
WA1200936OtherMEDICARE ID
WAA09261Medicare UPIN