Provider Demographics
NPI:1619386315
Name:BORGELLA, NADEGE
Entity Type:Individual
Prefix:
First Name:NADEGE
Middle Name:
Last Name:BORGELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 PENN PLZ
Mailing Address - Street 2:946
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10122-0049
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14 PENN PLZ
Practice Address - Street 2:946
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10122-0049
Practice Address - Country:US
Practice Address - Phone:212-470-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY794460131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist