Healthcare Provider Details

I. General information

NPI: 1043156177
Provider Name (Legal Business Name): RICHARD CHARLES BORECKI PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHARLIE BORECKI PA-C

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 STATE ST STE C
NORTH HAVEN CT
06473-3070
US

IV. Provider business mailing address

17 PROMONTORY DR
CHESHIRE CT
06410-1475
US

V. Phone/Fax

Practice location:
  • Phone: 203-672-2800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: