MEDICARE: YISSEL BORREGO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	26NJ15388700	NJ

General Provider Information

NPI Number	:	1326922469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YISSEL BORREGO APRN

Provider Business Mailing Address
First Line	:	3 UNIVERSITY PLZ STE 205
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-6208
Country	:	US
Telephone Number	:	201-833-3599
Fax Number	:	201-227-6207

Provider Business Practice Location Address
First Line	:	419 66TH ST
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-2401
Country	:	US
Telephone Number	:	201-861-9229
Fax Number	:	201-861-9272

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2025
Last Update Date	:	09/15/2025

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