Provider Demographics
NPI:1154482883
Name:PAEZ, JORGE ALBERTO (DC)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ALBERTO
Last Name:PAEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 DUTCHESS TPKE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-6444
Mailing Address - Country:US
Mailing Address - Phone:845-473-7750
Mailing Address - Fax:845-473-7804
Practice Address - Street 1:696 DUTCHESS TPKE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-6444
Practice Address - Country:US
Practice Address - Phone:845-473-7750
Practice Address - Fax:845-473-7804
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX2599-1111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX19621Medicare PIN
T98228Medicare UPIN