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General NPI Number Information
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NPI Number | 1831912278
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Entity Type | Individual
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Provider Name | SAMANTHA BORELLO FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1 BAY AVE
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City | MONTCLAIR
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State | NJ
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Zip | 07042-4837
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Country | US
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Telephone | 973-429-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TULIP CRES APT 1A
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City | LITTLE FALLS
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State | NJ
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Zip | 07424-1660
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Country | US
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Telephone | 718-594-5959
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | P01587000
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 26NR20484100
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License Number State | NJ
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