Provider Demographics
NPI:1003205311
Name:BORLAZA, NEPTHALIE
Entity Type:Individual
Prefix:
First Name:NEPTHALIE
Middle Name:
Last Name:BORLAZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16419 76TH AVE
Mailing Address - Street 2:2 FLR.
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16419 76TH AVE
Practice Address - Street 2:2 FLR.
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1250
Practice Address - Country:US
Practice Address - Phone:347-445-0202
Practice Address - Fax:718-417-1075
Is Sole Proprietor?:No
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist