Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 152472 | NY |
NPI | 1003891474 |
---|---|
Provider Name | Morton Borg |
First Address | Philadelphia, PA 19195-2436 |
Second Address | New York, NY 10003-3314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2005 |
Last Update Date | 15/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00997062 | (05) | NY |
C04669 | (02) |