Provider Demographics
NPI:1619304953
Name:CANO, PAOLA ANDREA (LMT)
Entity Type:Individual
Prefix:MS
First Name:PAOLA
Middle Name:ANDREA
Last Name:CANO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GODWIN AVE
Mailing Address - Street 2:
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407-2816
Mailing Address - Country:US
Mailing Address - Phone:305-713-4770
Mailing Address - Fax:
Practice Address - Street 1:100 GODWIN AVE
Practice Address - Street 2:
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407-2816
Practice Address - Country:US
Practice Address - Phone:305-713-4770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-01
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ18KT00633300171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor