Provider Demographics
NPI:1881664167
Name:BORAN & PUZZI EAR, NOSE & THROAT ASSOCIATES, PC
Entity Type:Organization
Organization Name:BORAN & PUZZI EAR, NOSE & THROAT ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BORAN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:570-621-5010
Mailing Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Mailing Address - Street 2:SUITE 205
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3663
Mailing Address - Country:US
Mailing Address - Phone:570-621-5010
Mailing Address - Fax:570-628-2525
Practice Address - Street 1:100 SCHUYLKILL MEDICAL PLZ
Practice Address - Street 2:SUITE 205
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3663
Practice Address - Country:US
Practice Address - Phone:570-621-5010
Practice Address - Fax:570-628-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030208E207Y00000X
PAAT0008696L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1332083OtherHIGHMARK BS
PACG9280OtherTRAVELERS MEDICARE
1332083OtherHIGHMARK BS