Boris Libster, D.O.

Primary specialty

SpecialistTaxonomy code 174400000X

License

25MB04369000 Issued in NJ

Practice address

217 White Horse Pike
Haddon Heights, NJ 08035-1703

Phone

(856) 547-1661

Fax

(856) 547-6117

NPI assigned

Oct 10, 2005

Sex

Male

Sole proprietor

No

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 Osteopathy

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

{
    "created_epoch": "1128902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495756800000",
    "number": "1659369122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 WHITE HORSE PIKE",
            "city": "HADDON HEIGHTS",
            "state": "NJ",
            "postal_code": "080351703",
            "telephone_number": "856-547-1661",
            "fax_number": "856-547-6117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 WHITE HORSE PIKE",
            "city": "HADDON HEIGHTS",
            "state": "NJ",
            "postal_code": "080351703",
            "telephone_number": "856-547-1661",
            "fax_number": "856-547-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIBSTER",
        "first_name": "BORIS",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-10",
        "last_updated": "2017-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NJ",
            "license": "25MB04369000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109180803",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Haddon Heights, NJ
• Providers in Haddon Heights, NJ by specialty
• Specialist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 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.