Healthcare Provider Details

I. General information

NPI: 1659207686
Provider Name (Legal Business Name): NOVUS REGENERATIVE INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 ORIENT WAY 3 FL SUITE B
RUTHERFORD NJ
07070
US

IV. Provider business mailing address

22-08 ROUTE 208 STE 13
FAIR LAWN NJ
07410-2609
US

V. Phone/Fax

Practice location:
  • Phone: 973-955-8836
  • Fax: 973-779-7385
Mailing address:
  • Phone: 973-779-7361
  • Fax: 973-779-7385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: BORIS MORDKOVICH
Title or Position: PRESIDENT
Credential:
Phone: 201-341-6566