Provider Demographics
NPI:1801503719
Name:BORST, ALIXANDRA VICTORIA (CNM)
Entity type:Individual
Prefix:
First Name:ALIXANDRA
Middle Name:VICTORIA
Last Name:BORST
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 SCHOLAR CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07417-1000
Mailing Address - Country:US
Mailing Address - Phone:845-544-6027
Mailing Address - Fax:
Practice Address - Street 1:25 LINDSLEY DR STE 201A
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4456
Practice Address - Country:US
Practice Address - Phone:973-998-7922
Practice Address - Fax:973-998-7925
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME00080601367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife