Provider Demographics
NPI:1831472034
Name:BORER, PAUL J (RD,MBA,MPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:BORER
Suffix:
Gender:M
Credentials:RD,MBA,MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WILBUR ROAD OPWDD OF NEW YORK STATE
Mailing Address - Street 2:HUDSON VALLEY DDSO
Mailing Address - City:THIELLS
Mailing Address - State:NY
Mailing Address - Zip Code:10984-0470
Mailing Address - Country:US
Mailing Address - Phone:845-947-6220
Mailing Address - Fax:845-947-6240
Practice Address - Street 1:11 WILBUR ROAD
Practice Address - Street 2:HUDSON VALLEY DDSO
Practice Address - City:THIELLS
Practice Address - State:NY
Practice Address - Zip Code:10984-0470
Practice Address - Country:US
Practice Address - Phone:845-947-6220
Practice Address - Fax:845-947-6240
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY865569133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered