Provider Demographics
NPI:1750646626
Name:CALINOG, PAUL ANTHONY (RPT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:CALINOG
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 BROAD AVE
Mailing Address - Street 2:#103
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1002
Mailing Address - Country:US
Mailing Address - Phone:201-390-3730
Mailing Address - Fax:201-390-3730
Practice Address - Street 1:845 BROAD AVE
Practice Address - Street 2:#103
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1002
Practice Address - Country:US
Practice Address - Phone:201-390-3730
Practice Address - Fax:201-390-3730
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-06
Last Update Date:2015-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01441600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA01441600OtherLICENSE