Provider Demographics
NPI:1285927806
Name:BORRES, MARIETA K (NP)
Entity type:Individual
Prefix:
First Name:MARIETA
Middle Name:K
Last Name:BORRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:564 1ST AVE
Mailing Address - Street 2:APT 17U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6482
Mailing Address - Country:US
Mailing Address - Phone:917-254-7990
Mailing Address - Fax:
Practice Address - Street 1:564 1ST AVE
Practice Address - Street 2:APT 17U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6482
Practice Address - Country:US
Practice Address - Phone:917-254-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-16
Last Update Date:2011-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430533-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care