Provider Demographics
NPI:1235891615
Name:PADUANO, BRYAN JAMES
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:JAMES
Last Name:PADUANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NORTH MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-2308
Mailing Address - Country:US
Mailing Address - Phone:516-707-5915
Mailing Address - Fax:
Practice Address - Street 1:935 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NORTH MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-2308
Practice Address - Country:US
Practice Address - Phone:516-707-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028390225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist