Provider Demographics
NPI:1285769851
Name:BORKOWSKI, DOUGLAS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:JOSEPH
Last Name:BORKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1109
Mailing Address - Country:US
Mailing Address - Phone:973-616-0240
Mailing Address - Fax:
Practice Address - Street 1:504 VALLEY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3534
Practice Address - Country:US
Practice Address - Phone:973-694-2690
Practice Address - Fax:973-694-2762
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05022000207RS0010X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ641758BK6Medicare PIN
NJ641758Medicare PIN
E66942Medicare UPIN