Healthcare Provider Details

I. General information

NPI: 1831472034
Provider Name (Legal Business Name): PAUL J BORER RD,MBA,MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBUR ROAD HUDSON VALLEY DDSO
THIELLS NY
10984-0470
US

IV. Provider business mailing address

11 WILBUR ROAD OPWDD OF NEW YORK STATE HUDSON VALLEY DDSO
THIELLS NY
10984-0470
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-6220
  • Fax: 845-947-6240
Mailing address:
  • Phone: 845-947-6220
  • Fax: 845-947-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number865569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: