Healthcare Provider Details

I. General information

NPI: 1326922469
Provider Name (Legal Business Name): YISSEL BORREGO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 09/15/2025
Certification Date: 09/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 66TH ST
WEST NEW YORK NJ
07093-2401
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-861-9229
  • Fax: 201-861-9272
Mailing address:
  • Phone: 201-833-3599
  • Fax: 201-227-6207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15388700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: