Provider Demographics
NPI:1710329198
Name:ALEYDA M BORGE MD PA
Entity Type:Organization
Organization Name:ALEYDA M BORGE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEYDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-404-7311
Mailing Address - Street 1:9710 STIRLING RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8018
Mailing Address - Country:US
Mailing Address - Phone:954-404-7311
Mailing Address - Fax:954-534-7930
Practice Address - Street 1:9710 STIRLING RD
Practice Address - Street 2:SUITE 103
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8018
Practice Address - Country:US
Practice Address - Phone:954-404-7311
Practice Address - Fax:954-534-7930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-25
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0059138207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE80192Medicare UPIN