Provider Demographics
NPI:1295316503
Name:BORKOWSKI, JACOB PATRICK
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:PATRICK
Last Name:BORKOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7508 171ST ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1417
Mailing Address - Country:US
Mailing Address - Phone:917-477-9530
Mailing Address - Fax:
Practice Address - Street 1:166 HANOVER ST STE 200
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-3544
Practice Address - Country:US
Practice Address - Phone:570-808-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program