Provider Demographics
NPI:1568030989
Name:BORRELLI, GERARD MICHAEL
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:MICHAEL
Last Name:BORRELLI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-1925
Mailing Address - Country:US
Mailing Address - Phone:860-945-3390
Mailing Address - Fax:860-945-3514
Practice Address - Street 1:26 DAVIS ST
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06779-1925
Practice Address - Country:US
Practice Address - Phone:860-945-3390
Practice Address - Fax:860-945-3514
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-13
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0012074183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist