Provider Demographics
NPI:1063568020
Name:BORGERSEN, RUDOLPH HAROLD
Entity type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:HAROLD
Last Name:BORGERSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 STILLWELLS CORNER RD
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-780-3330
Mailing Address - Fax:732-780-4385
Practice Address - Street 1:501 STILLWELLS CORNER RD
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-780-3330
Practice Address - Fax:732-780-4385
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C53687Medicare UPIN
B0169687Medicare ID - Type Unspecified