Provider Demographics
NPI:1619068244
Name:ARENA, PAUL ANTHONY (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:ARENA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST STE 111
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3009
Mailing Address - Country:US
Mailing Address - Phone:631-376-0600
Mailing Address - Fax:631-422-3723
Practice Address - Street 1:400 W MAIN ST STE 111
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3009
Practice Address - Country:US
Practice Address - Phone:631-376-0600
Practice Address - Fax:631-422-3723
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0206501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQM9561OtherBCBS
NYP2527535OtherOXFORD
NY3C9016OtherHEALTHNET
NY6604378OtherGHI
NYQH619QAPT1Medicare PIN