Provider Demographics
NPI:1598344558
Name:BORELLI, JEAN GENARO PEREIRA
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:GENARO PEREIRA
Last Name:BORELLI
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 1:280 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-1802
Mailing Address - Country:US
Mailing Address - Phone:617-480-4743
Mailing Address - Fax:
Practice Address - Street 1:80 MILL ST APT 2318
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1729
Practice Address - Country:US
Practice Address - Phone:617-480-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-06
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1017314207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty