Healthcare Provider Details

I. General information

NPI: 1427371343
Provider Name (Legal Business Name): LISA MARIE PALADINO MS, RNC, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2010
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2285 VICTORY BLVD
STATEN ISLAND NY
10314-6625
US

IV. Provider business mailing address

4945 AMBOY RD
STATEN ISLAND NY
10312-4842
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-3204
  • Fax:
Mailing address:
  • Phone: 718-966-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberF001318
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: