Provider Demographics
NPI:1114921483
Name:BORREGGINE, JOSEPH S (DPM)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:S
Last Name:BORREGGINE
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 WINKLER AVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9338
Mailing Address - Country:US
Mailing Address - Phone:239-278-4100
Mailing Address - Fax:239-278-3907
Practice Address - Street 1:2540 WINKLER AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-9338
Practice Address - Country:US
Practice Address - Phone:239-278-4100
Practice Address - Fax:239-278-3907
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-02
Last Update Date:2025-05-05
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-11
Provider Licenses
StateLicense IDTaxonomies
FL3812213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004288Medicaid
IL480033034OtherRAILROAD MEDICARE
IL60001631OtherBC/BS PROVIDER NUMBER
ILP01703981OtherRAILROAD MEDICARE
ILT39163Medicare UPIN
IL016004288Medicaid
ILF400312582Medicare PIN
IL208964Medicare PIN
ILK06355Medicare UPIN