Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35S100170000 | NJ |
Y | 103T00000X | Psychologist | 35S100170000 | NJ |
NPI | 1003824541 |
---|---|
Provider Name | Dr. Gary S Borer |
First Address | Fair Lawn, NJ 07410-3748 |
Second Address | Fair Lawn, NJ 07410-3748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 03/06/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0598305 | (05) | NJ |