Healthcare Provider Details

I. General information

NPI: 1942416771
Provider Name (Legal Business Name): DEANA E PALEY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

629 WASHINGTON ST STE 1
WATERTOWN NY
13601-4083
US

IV. Provider business mailing address

629 WASHINGTON ST STE 1
WATERTOWN NY
13601-4083
US

V. Phone/Fax

Practice location:
  • Phone: 315-755-3650
  • Fax: 315-755-3669
Mailing address:
  • Phone: 315-755-3650
  • Fax: 315-755-3669

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number249051
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number249051
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number249051
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: