Healthcare Provider Details

I. General information

NPI: 1851832786
Provider Name (Legal Business Name): JERALD BORGELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2017
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N 35TH AVE STE 650
HOLLYWOOD FL
33021-5471
US

IV. Provider business mailing address

2900 CORPORATE WAY STE D
MIRAMAR FL
33025-3925
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-5969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME157430
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: