Healthcare Provider Details

I. General information

NPI: 1902839830
Provider Name (Legal Business Name): HENRY BORRELLI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 ROCK AVE
GREEN BROOK NJ
08812-2616
US

IV. Provider business mailing address

366 UPPER MOUNTAIN AVE
UPPER MONTCLAIR NJ
07043-1436
US

V. Phone/Fax

Practice location:
  • Phone: 732-968-3900
  • Fax: 732-968-3944
Mailing address:
  • Phone: 732-968-3900
  • Fax: 732-968-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number25MD00227300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: