Healthcare Provider Details

I. General information

NPI: 1982645610
Provider Name (Legal Business Name): PAUL MISTHOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HAMILTON PLZ THIRD FLOOR
PATERSON NJ
07505-2109
US

IV. Provider business mailing address

328 W SAINT GEORGES AVE
LINDEN NJ
07036-5638
US

V. Phone/Fax

Practice location:
  • Phone: 973-278-6254
  • Fax:
Mailing address:
  • Phone: 908-925-7519
  • Fax: 908-925-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number49147
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: