Provider Demographics
NPI:1215209119
Name:FABBIE, PAULA (COM)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:FABBIE
Suffix:
Gender:F
Credentials:COM
Other - Prefix:MS
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:FABBIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, COM
Mailing Address - Street 1:140 MACKS LN
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12528-2142
Mailing Address - Country:US
Mailing Address - Phone:845-594-1854
Mailing Address - Fax:845-691-7622
Practice Address - Street 1:140 MACKS LN
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-2142
Practice Address - Country:US
Practice Address - Phone:845-594-1854
Practice Address - Fax:845-691-7622
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-08
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA178 C-12174400000X
NY013519124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Yes174400000XOther Service ProvidersSpecialist