MEDICARE: GREGORY MICHAEL BORSUK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	25MA02090900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0087200	OTHER	GHI
2	01000184900	OTHER	AMERICHOICE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	0083789000	OTHER	AMERIHEALTH HMO
5	145184	OTHER	AMERIHEALTH PPO
6	1047522	OTHER	HORIZON NJ HEALTH
7	P391182	OTHER	OXFORD
8	0462430	OTHER	AETNA
9	0K1557	OTHER	HEALTHNET
10	19566	OTHER	AMERIGROUP

General Provider Information

NPI Number	:	1083619084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY MICHAEL BORSUK M.D.

Provider Business Mailing Address
First Line	:	1416 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2825
Country	:	US
Telephone Number	:	732-349-2992
Fax Number	:	732-349-1026

Provider Business Practice Location Address
First Line	:	1416 HOOPER AVE
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2825
Country	:	US
Telephone Number	:	732-349-2992
Fax Number	:	732-349-1026

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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