Basic Information
Provider Information
NPI: 1669587903
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BORIN
FirstName: JAMES
MiddleName: FREDERIC
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 150 E 32ND ST FL 2
Address2:  
City: NEW YORK
State: NY
PostalCode: 100166058
CountryCode: US
TelephoneNumber: 6468256300
FaxNumber: 6468256399
Practice Location
Address1: 150 E 32ND ST FL 2
Address2:  
City: NEW YORK
State: NY
PostalCode: 100166058
CountryCode: US
TelephoneNumber: 6468256300
FaxNumber: 6468256399
Other Information
ProviderEnumerationDate: 08/19/2006
LastUpdateDate: 02/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X215552NYY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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