1942170147 NPI number — DR. MATTHEW LIAM BORODITSKY MD

Table of content: HADASSAH WRIGHT (NPI 1093422461)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942170147 NPI number — DR. MATTHEW LIAM BORODITSKY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORODITSKY
Provider First Name:
MATTHEW
Provider Middle Name:
LIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1942170147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1661 ONTARIO ST
Provider Second Line Business Mailing Address:
902
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
BC
Provider Business Mailing Address Postal Code:
V5Y 0C3
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
899 WEST 12TH AVENUE
Provider Second Line Business Practice Location Address:
2ND FLOOR, JIM PATTISON PAVILION
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
BC
Provider Business Practice Location Address Postal Code:
V5Z 1M9
Provider Business Practice Location Address Country Code:
CA
Provider Business Practice Location Address Telephone Number:
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/11/2025

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: 2082S0105X , with the licence number:  46149 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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