Healthcare Provider Details

I. General information

NPI: 1477780369
Provider Name (Legal Business Name): REYNALDO S PARAISO JR. D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 NORTHFIELD AVE SUITE 104
WEST ORANGE NJ
07052-1174
US

IV. Provider business mailing address

741 NORTHFIELD AVE SUITE 104
WEST ORANGE NJ
07052-1174
US

V. Phone/Fax

Practice location:
  • Phone: 973-243-0600
  • Fax: 973-243-0707
Mailing address:
  • Phone: 973-243-0600
  • Fax: 973-243-0707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number25MB08808500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: