Healthcare Provider Details

I. General information

NPI: 1538424270
Provider Name (Legal Business Name): PAULE GERTTY BORGELLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825-163 STREET
JAMAICA NY
11432
US

IV. Provider business mailing address

979 KINGS PKWY
NORTH BALDWIN NY
11510-2106
US

V. Phone/Fax

Practice location:
  • Phone: 718-739-0045
  • Fax:
Mailing address:
  • Phone: 917-687-7908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number298994
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number668613-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: