Boris Kholdarov, M.D.

Primary specialty

Occupational Medicine PhysicianTaxonomy code 2083X0100X

License

25MA09991600 Issued in NJ

Practice address

170 Frelinghuysen Rd
Room 212
Piscataway, NJ 08854-8020

Phone

(848) 445-6071

NPI assigned

Jan 29, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1485648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485648000000",
    "number": "1578000519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 FRELINGHUYSEN RD",
            "address_2": "ROOM 212",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "088548020",
            "telephone_number": "848-445-6071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 FRELINGHUYSEN RD",
            "address_2": "ROOM 212",
            "city": "PISCATAWAY",
            "state": "NJ",
            "postal_code": "088548020",
            "telephone_number": "848-445-6071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHOLDAROV",
        "first_name": "BORIS",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-29",
        "last_updated": "2017-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NJ",
            "license": "25MA09991600",
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "NY",
            "license": "287060",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keystone Community Living, Inc.
• Keystone Community Living, Inc.
• Keystone Community Living, Inc.
• Javeria Khan
• Najm Khan, MD
• Katharine Kicak
• Axel Kiefer, MD
• Risa Nicole Kiernan, DO
• Laurie Kiley
• Jenny Kim-Kosowski, D.O.

• Occupational Medicine Physician in Piscataway, NJ
• Providers in Piscataway, NJ by specialty
• Occupational Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2017; 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.