Provider Demographics
NPI:1396863882
Name:PARAISO, JOEL OROSA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:OROSA
Last Name:PARAISO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROSE CT
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1980
Mailing Address - Country:US
Mailing Address - Phone:732-557-1699
Mailing Address - Fax:
Practice Address - Street 1:403 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9728
Practice Address - Country:US
Practice Address - Phone:402-773-0115
Practice Address - Fax:402-773-0119
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1911232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01604920Medicaid
NY01604920Medicaid
NYF91345Medicare UPIN