Provider Demographics
NPI:1720114952
Name:BOROMISZA, ELOD TIBOR (DC PROGRAM NYCC)
Entity Type:Individual
Prefix:
First Name:ELOD
Middle Name:TIBOR
Last Name:BOROMISZA
Suffix:
Gender:M
Credentials:DC PROGRAM NYCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 604
Mailing Address - Street 2:
Mailing Address - City:SENECA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148-0604
Mailing Address - Country:US
Mailing Address - Phone:315-651-2474
Mailing Address - Fax:
Practice Address - Street 1:2360 STATE ROUTE 89
Practice Address - Street 2:#1271
Practice Address - City:SENECA FALLS
Practice Address - State:NY
Practice Address - Zip Code:13148-9425
Practice Address - Country:US
Practice Address - Phone:315-651-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program