Basic Information
| Provider Information | |||||||||
| NPI: | 1942699921 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY S BORER PHYSICIAN,P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 47 E 88TH ST | ||||||||
| Address2: | APT 2A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101281152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128314444 | ||||||||
| FaxNumber: | 2122496856 | ||||||||
| Practice Location | |||||||||
| Address1: | 635 MADISON AVE | ||||||||
| Address2: | 3RD FL | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100221009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122897777 | ||||||||
| FaxNumber: | 2122496856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2015 | ||||||||
| LastUpdateDate: | 01/14/2015 | ||||||||
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| AuthorizedOfficialLastName: | BORER | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | STEPHEN | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETER | ||||||||
| AuthorizedOfficialTelephone: | 2128314444 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 112183 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 00572110 | 05 | NY | MEDICAID |