Provider Demographics
NPI:1831537018
Name:BORK, STEPHANIE (APN)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:BORK
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:BORKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:834 WALNUT ST
Mailing Address - Street 2:SUITE 650
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:834 WALNUT ST
Practice Address - Street 2:SUITE 650
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-955-5161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00443900363LF0000X
PASP015699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103086772Medicaid
PA103086772Medicaid