Provider Demographics
NPI:1235301235
Name:HENRY R PAUL MD PLLC
Entity Type:Organization
Organization Name:HENRY R PAUL MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-604-5888
Mailing Address - Street 1:PO BOX 482
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-0482
Mailing Address - Country:US
Mailing Address - Phone:718-604-5888
Mailing Address - Fax:718-363-6879
Practice Address - Street 1:86 E 49TH STREET
Practice Address - Street 2:BLUMBERG SUITE B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-1901
Practice Address - Country:US
Practice Address - Phone:718-604-5888
Practice Address - Fax:718-363-6879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179494207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01749531Medicaid
NYF22799Medicare UPIN
NY35L171Medicare PIN