Provider Demographics
NPI:1023079431
Name:BORRELLI, KARIN (MD)
Entity type:Individual
Prefix:DR
First Name:KARIN
Middle Name:
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CHARLTON RD
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-2547
Mailing Address - Country:US
Mailing Address - Phone:518-399-7723
Mailing Address - Fax:518-399-6428
Practice Address - Street 1:112 CHARLTON RD
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-2547
Practice Address - Country:US
Practice Address - Phone:518-399-7723
Practice Address - Fax:518-399-6428
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237259-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02691303Medicaid
NYI46879Medicare UPIN
NYRA8859Medicare PIN