Healthcare Provider Details

I. General information

NPI: 1598011645
Provider Name (Legal Business Name): FELIX PAULINO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

475 COLONIAL TER APT 5
HACKENSACK NJ
07601-1426
US

IV. Provider business mailing address

475 COLONIAL TER APT 5
HACKENSACK NJ
07601-1426
US

V. Phone/Fax

Practice location:
  • Phone: 917-748-7650
  • Fax:
Mailing address:
  • Phone: 917-748-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: