Provider Demographics
NPI:1285002824
Name:BOREN, JEFFREY THOMAS (HIS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:THOMAS
Last Name:BOREN
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 STONEWOOD DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-7376
Mailing Address - Country:US
Mailing Address - Phone:724-933-3440
Mailing Address - Fax:734-933-3446
Practice Address - Street 1:7000 STONEWOOD DR
Practice Address - Street 2:SUITE 210
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-933-3440
Practice Address - Fax:734-933-3446
Is Sole Proprietor?:No
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAF03570237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist