Basic Information
| Provider Information | |||||||||
| NPI: | 1659673986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BORRERO | ||||||||
| FirstName: | JESSICA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 33RD ST STE 306 | ||||||||
| Address2: | |||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111062329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444034325 | ||||||||
| FaxNumber: | 4246250010 | ||||||||
| Practice Location | |||||||||
| Address1: | 3636 33RD ST STE 306 | ||||||||
| Address2: | |||||||||
| City: | LONG ISLAND CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 111062329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8444034325 | ||||||||
| FaxNumber: | 4246250010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/18/2010 | ||||||||
| LastUpdateDate: | 05/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 014379 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.