Provider Demographics
NPI:1033292867
Name:PARADISO, MARY JO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY JO
Middle Name:
Last Name:PARADISO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3946
Mailing Address - Country:US
Mailing Address - Phone:732-906-1900
Mailing Address - Fax:732-906-6666
Practice Address - Street 1:113 JAMES ST
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3946
Practice Address - Country:US
Practice Address - Phone:732-906-1900
Practice Address - Fax:732-906-6666
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA056530207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG08901Medicare UPIN
NJ784259PAXMedicare ID - Type Unspecified