Provider Demographics
NPI:1265860613
Name:PAUL PYO MD LLC
Entity Type:Organization
Organization Name:PAUL PYO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:PYO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-880-8952
Mailing Address - Street 1:1166 SAINT GEORGES AVE
Mailing Address - Street 2:
Mailing Address - City:AVENEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07001-1263
Mailing Address - Country:US
Mailing Address - Phone:732-636-6113
Mailing Address - Fax:732-636-1006
Practice Address - Street 1:1166 SAINT GEORGES AVE
Practice Address - Street 2:
Practice Address - City:AVENEL
Practice Address - State:NJ
Practice Address - Zip Code:07001-1263
Practice Address - Country:US
Practice Address - Phone:732-636-6113
Practice Address - Fax:732-636-1006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08498200208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty