Active NPI
Boris Paul, M.D.,F.A.C.S
- Vascular Surgery Physician
- East Stroudsburg, PA
National Provider Identifier
1164420816
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- MD028193E
- Practice address
- 505 Independence Rd
Ste E
East Stroudsburg, PA 18301-7916 - Phone
- (570) 421-5997
- Fax
- (570) 421-7635
- NPI assigned
- Jul 7, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Vascular Surgery Physician | 2086S0129X | MD028193E | PA | Primary |
| Surgery Physician | 208600000X | 138069-1 | NY | |
| Surgery Physician | 208600000X | ME 121565 | FL |
Addresses
Primary practice location
505 Independence Rd
Ste E
East Stroudsburg, PA 18301-7916
Mailing address
505 Independence Rd
Suite E
East Stroudsburg, PA 18301-7916
Phone (570) 421-5997
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001152624007 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME 121565 | FL | MD | Surgery Physician |
| 138069-1 | NY | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pocono Ambulatory Surgery Center LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Ambulatory Surgical Clinic/Center
- Stroudsburg, PA
- NPI 1265435176
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428537600000",
"number": "1164420816",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 INDEPENDENCE RD",
"address_2": "SUITE E",
"city": "EAST STROUDSBURG",
"state": "PA",
"postal_code": "183017916",
"telephone_number": "570-421-5997",
"fax_number": "570-421-7635"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 INDEPENDENCE RD",
"address_2": "STE E",
"city": "EAST STROUDSBURG",
"state": "PA",
"postal_code": "183017916",
"telephone_number": "570-421-5997",
"fax_number": "570-421-7635"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAUL",
"first_name": "BORIS",
"name_prefix": "Dr.",
"credential": "M.D.,F.A.C.S",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-07",
"last_updated": "2015-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "PA",
"license": "MD028193E",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "138069-1",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "FL",
"license": "ME 121565",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001152624007",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in East Stroudsburg, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.