Healthcare Provider Details

I. General information

NPI: 1295704070
Provider Name (Legal Business Name): HAROLD PAEZ D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12610 ROCKAWAY BEACH BLVD
BELLE HARBOR NY
11694-1739
US

IV. Provider business mailing address

12610 ROCKAWAY BEACH BLVD
BELLE HARBOR NY
11694-1739
US

V. Phone/Fax

Practice location:
  • Phone: 917-579-3557
  • Fax: 917-579-3557
Mailing address:
  • Phone: 718-945-4995
  • Fax: 718-945-4995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN005206
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: