Provider Demographics
NPI:1891831186
Name:DESERIO, PAUL DAMON (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:DAMON
Last Name:DESERIO
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Gender:M
Credentials:PHYSICAL THERAPIST
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Mailing Address - Street 1:8801 19TH AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4684
Mailing Address - Country:US
Mailing Address - Phone:888-806-2497
Mailing Address - Fax:888-806-5151
Practice Address - Street 1:201 CONSELYEA ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-2516
Practice Address - Country:US
Practice Address - Phone:718-782-1462
Practice Address - Fax:718-834-0768
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-06-20
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Provider Licenses
StateLicense IDTaxonomies
NY022443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL5661Medicare PIN