Individual provider Active NPI

Gary I. Borker, D.M.D.

  • General Practice Dentistry
  • Clark, NJ
National Provider Identifier
1891884201
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DI017449 Issued in NJ
Practice address
1139 Raritan Rd
Suite 203
Clark, NJ 07066-1344
Phone
(732) 381-5550
Fax
(732) 381-6734
NPI assigned
Oct 12, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DI017449 NJ Primary

Addresses

Primary practice location

1139 Raritan Rd
Suite 203
Clark, NJ 07066-1344

Mailing address

1139 Raritan Rd
Suite 203
Clark, NJ 07066-1344
Phone (732) 381-5550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150826000140 NJ Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 7517273212

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DI017449NJMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1891884201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1139 RARITAN RD",
            "address_2": "SUITE 203",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661344",
            "telephone_number": "732-381-5550",
            "fax_number": "732-381-6734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1139 RARITAN RD",
            "address_2": "SUITE 203",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661344",
            "telephone_number": "732-381-5550",
            "fax_number": "732-381-6734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORKER",
        "first_name": "GARY",
        "middle_name": "I.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "DI017449",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

Verify at the official NPI Registry.