Provider Demographics
NPI:1003018920
Name:BORJA, NINO POMPEYO ROCCO ALTAMIRANO (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:NINO POMPEYO ROCCO
Middle Name:ALTAMIRANO
Last Name:BORJA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 WOODFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WEST HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-2528
Mailing Address - Country:US
Mailing Address - Phone:908-922-5762
Mailing Address - Fax:516-565-0929
Practice Address - Street 1:6241 WOODHAVEN BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-3731
Practice Address - Country:US
Practice Address - Phone:929-607-3271
Practice Address - Fax:929-607-3267
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06050059Medicaid
12029482OtherCAQH