Provider Demographics
NPI:1851659338
Name:PAZ, RENATO RAFAEL JR (PT)
Entity Type:Individual
Prefix:MR
First Name:RENATO
Middle Name:RAFAEL
Last Name:PAZ
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:RENATO
Other - Middle Name:RAFAEL
Other - Last Name:PAZ
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:224 W 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:224 W 30TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4905
Practice Address - Country:US
Practice Address - Phone:845-665-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-02
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034388-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist