Healthcare Provider Details

I. General information

NPI: 1215955075
Provider Name (Legal Business Name): PAUL M REO RPA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 MCCLELLAN ST
SCHENECTADY NY
12304-1009
US

IV. Provider business mailing address

600 MCCLELLAN ST
SCHENECTADY NY
12304-1009
US

V. Phone/Fax

Practice location:
  • Phone: 518-347-5606
  • Fax: 518-347-5409
Mailing address:
  • Phone: 518-347-5606
  • Fax: 518-347-5409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number006318-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: