1194883793 NPI number — CARL BORIS D.O.

Table of content: CARL BORIS D.O. (NPI 1194883793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194883793 NPI number — CARL BORIS D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORIS
Provider First Name:
CARL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1194883793
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
99 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASSAPEQUA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11758-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-795-2626
Provider Business Mailing Address Fax Number:
516-799-7451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MASSAPEQUA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11758-1203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-541-9700
Provider Business Practice Location Address Fax Number:
516-798-1086
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  089458 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 201285536 . This is a "EMPIRE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5491B1 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5C4402 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP624 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4115108 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 089458 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5061 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5996232 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00230863 . This is a "RR MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201285536 . This is a "MAGNACARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 785722 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00404884 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201285536 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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