Provider Demographics
NPI:1053453357
Name:WINSTON B PALEY MD PC
Entity Type:Organization
Organization Name:WINSTON B PALEY MD PC
Other - Org Name:WINSTON PALEY MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT 100 DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WINSTON
Authorized Official - Middle Name:B
Authorized Official - Last Name:PALEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-487-4408
Mailing Address - Street 1:935 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-487-4408
Mailing Address - Fax:516-487-4543
Practice Address - Street 1:935 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE 202
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-487-4408
Practice Address - Fax:516-487-4543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096945207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAP3482623OtherDEA
NYAP3482623OtherDEA
B80029Medicare ID - Type Unspecified