Provider Demographics
NPI:1326212242
Name:DE LEON-BORRES, MERCEDES P (LPT)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:P
Last Name:DE LEON-BORRES
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 PARK AVE STE 102
Mailing Address - Street 2:C/O CENTRAL JERSEY ORTHOPAEDIC SPECIALISTS,P.A.
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5530
Mailing Address - Country:US
Mailing Address - Phone:908-561-2220
Mailing Address - Fax:908-769-5308
Practice Address - Street 1:1907 PARK AVE STE 102
Practice Address - Street 2:C/O CENTRAL JERSEY ORTHOPAEDIC SPECIALISTS,P.A.
Practice Address - City:SOUTH PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07080-5530
Practice Address - Country:US
Practice Address - Phone:908-561-2220
Practice Address - Fax:908-769-5308
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00733900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ126868DVLMedicare PIN