Provider Demographics
NPI:1902133531
Name:BORJA, KAREN OCHOA
Entity Type:Individual
Prefix:
First Name:KAREN OCHOA
Middle Name:
Last Name:BORJA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 FORD AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5660
Mailing Address - Country:US
Mailing Address - Phone:215-550-1360
Mailing Address - Fax:215-710-8154
Practice Address - Street 1:25 FORD AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5660
Practice Address - Country:US
Practice Address - Phone:215-550-1360
Practice Address - Fax:215-710-8154
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-03
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029228-1171W00000X
PAPT020476225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No171W00000XOther Service ProvidersContractor