Provider Demographics
NPI:1194718130
Name:EPSTEIN, BORIS
Entity type:Individual
Prefix:DR
First Name:BORIS
Middle Name:
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 CRANBURY RD
Mailing Address - Street 2:STE 104
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4098
Mailing Address - Country:US
Mailing Address - Phone:732-698-7171
Mailing Address - Fax:
Practice Address - Street 1:620 CRANBURY RD
Practice Address - Street 2:
Practice Address - City:E BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4000
Practice Address - Country:US
Practice Address - Phone:732-698-2444
Practice Address - Fax:732-698-9844
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07361000207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8905304Medicaid
NJ8905304Medicaid