1013090729 NPI number — STEPHEN V BORIS MD PC

Table of content: (NPI 1013090729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013090729 NPI number — STEPHEN V BORIS MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STEPHEN V BORIS MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013090729
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
895 MAMARONECK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANARONECK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-698-6666
Provider Business Mailing Address Fax Number:
914-698-6681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
895 MAMARONECK AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANARONECK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-698-6666
Provider Business Practice Location Address Fax Number:
914-698-6681
Provider Enumeration Date:
10/24/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BORIS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
914-698-6666

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  099770 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 208000000X , with the licence number: 099770 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00443265 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".