Provider Demographics
NPI:1932153079
Name:BORKOWSKI, VICTOR DANIEL (OD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:DANIEL
Last Name:BORKOWSKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1253
Mailing Address - Country:US
Mailing Address - Phone:732-367-1881
Mailing Address - Fax:732-367-2462
Practice Address - Street 1:1700 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1253
Practice Address - Country:US
Practice Address - Phone:732-367-1881
Practice Address - Fax:732-367-2462
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00411700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0979201-01Medicaid
NJ410000781Medicare PIN
NJ0979201-01Medicaid
NJ0605640001Medicare NSC