Healthcare Provider Details

I. General information

NPI: 1891665568
Provider Name (Legal Business Name): MR. PAUL RICHARD VAHER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 33RD ST STE 502
ASTORIA NY
11106-2329
US

IV. Provider business mailing address

3636 33RD ST STE 502
ASTORIA NY
11106-2329
US

V. Phone/Fax

Practice location:
  • Phone: 718-426-8110
  • Fax: 718-426-8117
Mailing address:
  • Phone: 718-426-8110
  • Fax: 718-426-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number129758
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: