Provider Demographics
NPI:1174846620
Name:DANIEL J PAULO MD PC
Entity Type:Organization
Organization Name:DANIEL J PAULO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAULO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-273-2800
Mailing Address - Street 1:1032 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3622
Mailing Address - Country:US
Mailing Address - Phone:718-273-2800
Mailing Address - Fax:718-876-7810
Practice Address - Street 1:1032 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3622
Practice Address - Country:US
Practice Address - Phone:718-273-2800
Practice Address - Fax:718-876-7810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY085615207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTO BE ASSIGNEDMedicare PIN