Active NPI
Robert Borodkin, M.D.
- Psychiatry Physician
- Rolling Hills Estates, CA
National Provider Identifier
1700944600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A18302
- Practice address
- 927 Deep Valley Drive
Rolling Hills Estates, CA 90274-4123 - Phone
- (310) 541-2542
- NPI assigned
- Dec 4, 2006
- Reactivated
- Nov 21, 2017
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A18302 | CA | Primary |
Addresses
Primary practice location
927 Deep Valley Drive
Rolling Hills Estates, CA 90274-4123
Mailing address
24 Pony Lane
Rolling Hills Estates, CA 90274-4123
Phone (310) 377-8851
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A18302 | Other | CA | STATE LICENSE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1511222400000",
"number": "1700944600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 PONY LANE",
"city": "ROLLING HILLS ESTATES",
"state": "CA",
"postal_code": "902744123",
"telephone_number": "310-377-8851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "927 DEEP VALLEY DRIVE",
"city": "ROLLING HILLS ESTATES",
"state": "CA",
"postal_code": "902744123",
"telephone_number": "310-541-2542"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORODKIN",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-04",
"last_updated": "2017-11-21",
"deactivation_date": "2015-11-10",
"reactivation_date": "2017-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A18302",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "A18302",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rolling Hills Estates, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 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.