Edward B Borden, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

133133 Issued in NY

Practice address

625 Belle Terre Rd Ste 201
Port Jefferson, NY 11777-2318

Phone

(631) 474-0707

Fax

(631) 474-4034

NPI assigned

Jul 19, 2006

Last updated

Oct 20, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Suffolk Surgical Assoc

  • Specialist
  • Port Jefferson, NY
  • NPI 1447414370
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1413763200000",
    "number": "1316966245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 ROUTE 25A",
            "city": "ROCKY POINT",
            "state": "NY",
            "postal_code": "117788556",
            "telephone_number": "631-474-0707",
            "fax_number": "631-474-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 BELLE TERRE RD STE 201",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117772318",
            "telephone_number": "631-474-0707",
            "fax_number": "631-474-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORDEN",
        "first_name": "EDWARD",
        "middle_name": "B",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2014-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NY",
            "license": "133133",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00718209",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corien Bologna, LCAT, ATR-BC
• Anthony Bolton, PHD
• Ramyaprabha Bondalapati, MD
• Carol Elizabeth Bonura, NP
• Joanna Rose Bonura, LMHC, CASAC-2
• Michael Borrero
• Abir Bose, MD
• Jessica Paige Boswell
• Melody Ann Bottan, MSOTR/L
• Marlene G Bould, SLP

• Surgery Physician in Port Jefferson, NY
• Providers in Port Jefferson, NY by specialty
• Surgery Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.