Healthcare Provider Details

I. General information

NPI: 1942399407
Provider Name (Legal Business Name): ALAN J BORISLOW D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD ALBERT EINSTEIN MED. CTR., PALEY 2
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

5501 OLD YORK RD ALBERT EINSTEIN MED. CTR., PALEY 2
PHILADELPHIA PA
19141-3018
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-7104
  • Fax: 215-456-3482
Mailing address:
  • Phone: 215-456-7104
  • Fax: 215-456-3482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS014759L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: