Provider Demographics
NPI:1457443103
Name:FODDAI, PAUL ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:FODDAI
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 1:142 PALISADE AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1133
Mailing Address - Country:US
Mailing Address - Phone:201-795-0904
Mailing Address - Fax:201-795-3450
Practice Address - Street 1:142 PALISADE AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-1133
Practice Address - Country:US
Practice Address - Phone:201-795-0904
Practice Address - Fax:201-795-3450
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03814700207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ449997Medicare ID - Type Unspecified
NJC55015Medicare UPIN