Healthcare Provider Details

I. General information

NPI: 1659660090
Provider Name (Legal Business Name): NEIL A BORJA D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 12/21/2023
Certification Date: 12/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 W TWIN OAKS TER STE 12
SOUTH BURLINGTON VT
05403-7141
US

IV. Provider business mailing address

54 W TWIN OAKS TER STE 12
SOUTH BURLINGTON VT
05403-7141
US

V. Phone/Fax

Practice location:
  • Phone: 802-343-2659
  • Fax: 802-499-2545
Mailing address:
  • Phone: 802-343-2659
  • Fax: 802-499-2545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number032.0133990
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number032.0133990
License Number StateVT
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0320133990
License Number StateVT
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.012111
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number032.0133990
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: