Basic Information
| Provider Information | |||||||||
| NPI: | 1003018920 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BORJA | ||||||||
| FirstName: | NINO POMPEYO ROCCO | ||||||||
| MiddleName: | ALTAMIRANO | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 245 WOODFIELD RD | ||||||||
| Address2: | |||||||||
| City: | WEST HEMPSTEAD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115522528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9089225762 | ||||||||
| FaxNumber: | 5165650929 | ||||||||
| Practice Location | |||||||||
| Address1: | 60 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112126705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186843319 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 028810 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 12029482 | 01 | CAQH | OTHER | 06050059 | 05 | NY | MEDICAID |