Provider Demographics
NPI:1407341936
Name:BORJE, JILLIANE MARI ROA
Entity type:Individual
Prefix:
First Name:JILLIANE MARI
Middle Name:ROA
Last Name:BORJE
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 1:1685 E 5TH ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-6919
Mailing Address - Country:US
Mailing Address - Phone:646-891-6235
Mailing Address - Fax:
Practice Address - Street 1:1685 E 5TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-6919
Practice Address - Country:US
Practice Address - Phone:646-891-6235
Practice Address - Fax:646-891-6235
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042638225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist