Provider Demographics
NPI:1407636483
Name:BORK, CONSTANCE CLARE (LAC)
Entity Type:Individual
Prefix:MISS
First Name:CONSTANCE
Middle Name:CLARE
Last Name:BORK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 MOUNT NEBO RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08848-1237
Mailing Address - Country:US
Mailing Address - Phone:908-217-9614
Mailing Address - Fax:
Practice Address - Street 1:83 PARK AVE
Practice Address - Street 2:
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-1128
Practice Address - Country:US
Practice Address - Phone:908-968-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00168100171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist