Provider Demographics
NPI:1174503197
Name:PAONESSA, NINA J (DO, FACOS)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:J
Last Name:PAONESSA
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Gender:F
Credentials:DO, FACOS
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Mailing Address - Street 1:2101 ROUTE 34 SOUTH
Mailing Address - Street 2:SUITE H
Mailing Address - City:WALL
Mailing Address - State:NJ
Mailing Address - Zip Code:07719
Mailing Address - Country:US
Mailing Address - Phone:732-282-1500
Mailing Address - Fax:732-282-1501
Practice Address - Street 1:603 HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:BRIELLE
Practice Address - State:NJ
Practice Address - Zip Code:08730-1476
Practice Address - Country:US
Practice Address - Phone:732-282-1500
Practice Address - Fax:732-282-1501
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2019-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB08475900208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery