Healthcare Provider Details

I. General information

NPI: 1942170147
Provider Name (Legal Business Name): MATTHEW LIAM BORODITSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 WEST 12TH AVENUE 2ND FLOOR, JIM PATTISON PAVILION
VANCOUVER BC
V5Z 1M9
CA

IV. Provider business mailing address

1661 ONTARIO ST 902
VANCOUVER BC
V5Y 0C3
CA

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number46149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: