Provider Demographics
NPI:1780616417
Name:BORROMEO, CHARLES N (MED, ATC)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:N
Last Name:BORROMEO
Suffix:
Gender:M
Credentials:MED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SILVER HILL LN
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4731
Mailing Address - Country:US
Mailing Address - Phone:609-636-7441
Mailing Address - Fax:856-222-9714
Practice Address - Street 1:901 ROUTE 73 N STE B
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2034
Practice Address - Country:US
Practice Address - Phone:856-222-9713
Practice Address - Fax:856-222-9714
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000583002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ029402422OtherNATA BOC CERT #
NJ25MT00058300OtherNEW JERSEY LICENSE/REG #
NJ1023055381OtherNPI-2 ORGANIZATION
NJ922067OtherN.A.T.A. MEMBER #