Provider Demographics
NPI:1073838116
Name:PANA, MARJORIE BORJA (PT)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:BORJA
Last Name:PANA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 METROPOLITAN AVE
Mailing Address - Street 2:APARTMENT 3F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-6831
Mailing Address - Country:US
Mailing Address - Phone:347-445-4950
Mailing Address - Fax:
Practice Address - Street 1:1504 METROPOLITAN AVE
Practice Address - Street 2:APARTMENT 3F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-6831
Practice Address - Country:US
Practice Address - Phone:347-445-4950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY032529225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist