Provider Demographics
NPI:1427186808
Name:PAEZ, PATRICIO R (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIO
Middle Name:R
Last Name:PAEZ
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 1:401 W END AVE
Mailing Address - Street 2:1-C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5724
Mailing Address - Country:US
Mailing Address - Phone:212-724-5354
Mailing Address - Fax:
Practice Address - Street 1:401 W END AVE
Practice Address - Street 2:1-C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5724
Practice Address - Country:US
Practice Address - Phone:212-724-5354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1483802084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry