Provider Demographics
NPI:1093818205
Name:PAUL, EDWARD MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MARK
Last Name:PAUL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:155 E 31ST ST
Mailing Address - Street 2:25 J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6800
Mailing Address - Country:US
Mailing Address - Phone:212-447-5712
Mailing Address - Fax:212-447-1331
Practice Address - Street 1:155 E 31ST ST
Practice Address - Street 2:25 J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6800
Practice Address - Country:US
Practice Address - Phone:212-447-5712
Practice Address - Fax:212-447-1331
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY1570242084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
P692802OtherOXFORD
NYA60309Medicare UPIN