Provider Demographics
NPI:1609049345
Name:CARLOS P. BORROMEO, JR., M.D., PA
Entity Type:Organization
Organization Name:CARLOS P. BORROMEO, JR., M.D., PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:P
Authorized Official - Last Name:BORROMEO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:856-663-3725
Mailing Address - Street 1:5052 WESTFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08110-2818
Mailing Address - Country:US
Mailing Address - Phone:856-663-3725
Mailing Address - Fax:856-663-1550
Practice Address - Street 1:5052 WESTFIELD AVE
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08110-2818
Practice Address - Country:US
Practice Address - Phone:856-663-3725
Practice Address - Fax:856-663-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02665200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
0079604001OtherAMERIHEALTH
NJ6329403Medicaid
=========OtherTAX ID
NJB01104089Medicare PIN