Healthcare Provider Details

I. General information

NPI: 1003891474
Provider Name (Legal Business Name): MORTON BORG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQ E STE 5M
NEW YORK NY
10003-3314
US

IV. Provider business mailing address

PO BOX 95000-2436
PHILADELPHIA PA
19195-2436
US

V. Phone/Fax

Practice location:
  • Phone: 212-844-8300
  • Fax:
Mailing address:
  • Phone: 212-844-8313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number152472
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number152472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: