MEDICARE: PATRICIO R PAEZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	148380	NY

General Provider Information

NPI Number	:	1427186808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIO R PAEZ M.D.

Provider Business Mailing Address
First Line	:	401 W END AVE
Second Line	:	1-C
City	:	NEW YORK
State	:	NY
Zip	:	10024-5724
Country	:	US
Telephone Number	:	212-724-5354
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W END AVE
Second Line	:	1-C
City	:	NEW YORK
State	:	NY
Zip	:	10024-5724
Country	:	US
Telephone Number	:	212-724-5354
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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