Provider Demographics
NPI:1447572714
Name:CELLA, PAUL ROBERT (PA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ROBERT
Last Name:CELLA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:ROBERT
Other - Last Name:CELLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1 ROBIN HILL LN
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-1000
Mailing Address - Country:US
Mailing Address - Phone:631-697-4047
Mailing Address - Fax:
Practice Address - Street 1:1 ROBIN HILL LN
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-1000
Practice Address - Country:US
Practice Address - Phone:631-697-4047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP74666363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant