Provider Demographics
NPI:1467457663
Name:BORKOWSKI, JOHN J (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BORKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3647
Mailing Address - Country:US
Mailing Address - Phone:860-346-8657
Mailing Address - Fax:860-347-9554
Practice Address - Street 1:85 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3647
Practice Address - Country:US
Practice Address - Phone:860-346-8657
Practice Address - Fax:860-347-9554
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18705174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010018705CT01OtherANTHEM
CT7282240 004OtherCIGNA
CT710235OtherCONNCTICARE
CTOV0069OtherHEALTHNET
CT535508OtherAETNA
CT7282240 004OtherCIGNA