Provider Demographics
NPI:1639194863
Name:BORKOWSKI, JESSICA M (PA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:BORKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:336 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06117-2510
Mailing Address - Country:US
Mailing Address - Phone:860-232-4891
Mailing Address - Fax:860-236-1016
Practice Address - Street 1:336 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06117-2510
Practice Address - Country:US
Practice Address - Phone:860-232-4891
Practice Address - Fax:860-236-1016
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001558363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1639194863Medicaid
CT1639194863OtherNPI
1639194863Medicare PIN
CTQ37945Medicare UPIN