Healthcare Provider Details

I. General information

NPI: 1427022896
Provider Name (Legal Business Name): ROBERT PAE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 12TH ST SPELLMAN 7
NEW YORK NY
10011-8202
US

IV. Provider business mailing address

170 W 12TH ST SPELLMAN 7
NEW YORK NY
10011-8202
US

V. Phone/Fax

Practice location:
  • Phone: 212-604-6265
  • Fax:
Mailing address:
  • Phone: 212-604-6265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number214203
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: