Provider Demographics
NPI:1558453803
Name:BORRELLI, KRISTINA (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 LATTIMORE RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-4159
Mailing Address - Country:US
Mailing Address - Phone:585-244-9720
Mailing Address - Fax:585-244-9995
Practice Address - Street 1:125 LATTIMORE RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-4159
Practice Address - Country:US
Practice Address - Phone:585-244-9720
Practice Address - Fax:585-244-9995
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333445-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics