Provider Demographics
NPI:1912207341
Name:PADDOCK, ALISON L (40QB00266000)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:L
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:40QB00266000
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 EKINGS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:HAWTHORNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07506-1151
Mailing Address - Country:US
Mailing Address - Phone:973-632-0261
Mailing Address - Fax:
Practice Address - Street 1:186 PARAMUS RD
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1309
Practice Address - Country:US
Practice Address - Phone:201-843-3169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00266000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant