Provider Demographics
NPI:1104405240
Name:BORRERO, NATHAN (MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BORRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8519
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-8519
Mailing Address - Country:US
Mailing Address - Phone:732-460-9840
Mailing Address - Fax:732-460-9848
Practice Address - Street 1:18 LEONARDVILLE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NJ
Practice Address - Zip Code:07748-2311
Practice Address - Country:US
Practice Address - Phone:732-671-0860
Practice Address - Fax:732-671-6467
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA12210300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine