Provider Demographics
NPI:1104121565
Name:BORRES, DOLORES A (PT)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:A
Last Name:BORRES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DOLORES
Other - Middle Name:L
Other - Last Name:ACEJO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:20 PEACHTREE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-4616
Mailing Address - Country:US
Mailing Address - Phone:631-467-3700
Mailing Address - Fax:631-467-0928
Practice Address - Street 1:18005 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-4727
Practice Address - Country:US
Practice Address - Phone:718-262-5877
Practice Address - Fax:718-906-5741
Is Sole Proprietor?:No
Enumeration Date:2011-01-17
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031876-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist