Provider Demographics
NPI:1083980890
Name:BOROWKA, MATTHEW R (RD, C D-N)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:BOROWKA
Suffix:
Gender:M
Credentials:RD, C D-N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BAKER LN
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3506
Mailing Address - Country:US
Mailing Address - Phone:516-860-6475
Mailing Address - Fax:
Practice Address - Street 1:12 BAKER LN
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3506
Practice Address - Country:US
Practice Address - Phone:516-860-6475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006881133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered