Provider Demographics
NPI:1558643221
Name:DEJESUS, LADY PAULA JOSE (DPM)
Entity Type:Individual
Prefix:DR
First Name:LADY PAULA
Middle Name:JOSE
Last Name:DEJESUS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3078 34TH ST
Mailing Address - Street 2:#4C
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11103-5253
Mailing Address - Country:US
Mailing Address - Phone:305-498-9013
Mailing Address - Fax:
Practice Address - Street 1:7523 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-2342
Practice Address - Country:US
Practice Address - Phone:718-745-7266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006439213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine