Provider Demographics
NPI:1114279742
Name:PAUL PEZZINO, MD OF NY P.C.
Entity Type:Organization
Organization Name:PAUL PEZZINO, MD OF NY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEZZINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-564-4031
Mailing Address - Street 1:330 MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1851
Mailing Address - Country:US
Mailing Address - Phone:203-518-4888
Mailing Address - Fax:203-518-4889
Practice Address - Street 1:9117 157TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414
Practice Address - Country:US
Practice Address - Phone:718-564-4031
Practice Address - Fax:203-518-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266310208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty