Provider Demographics
NPI:1467590026
Name:BORRES, WARREN (PT)
Entity Type:Individual
Prefix:
First Name:WARREN
Middle Name:
Last Name:BORRES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 GREYHOUND CT
Mailing Address - Street 2:
Mailing Address - City:KENDALL PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08824-1492
Mailing Address - Country:US
Mailing Address - Phone:201-558-0808
Mailing Address - Fax:201-558-0877
Practice Address - Street 1:1625 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-6302
Practice Address - Country:US
Practice Address - Phone:201-558-0808
Practice Address - Fax:201-558-0877
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00766400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066705Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER