Provider Demographics
NPI: | 1942208046 |
---|---|
Name: | ALESSI, PAUL J (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | PAUL |
Middle Name: | J |
Last Name: | ALESSI |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 457 HADDONFIELD RD |
Mailing Address - Street 2: | SUITE D1 |
Mailing Address - City: | CHERRY HILL |
Mailing Address - State: | NJ |
Mailing Address - Zip Code: | 08002-2220 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 856-406-4091 |
Mailing Address - Fax: | 856-406-4570 |
Practice Address - Street 1: | 457 HADDONFIELD ROAD |
Practice Address - Street 2: | SUITE D1 |
Practice Address - City: | CHERRY HILL |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08002 |
Practice Address - Country: | US |
Practice Address - Phone: | 856-406-4091 |
Practice Address - Fax: | 856-406-4570 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-07-12 |
Last Update Date: | 2013-02-25 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NJ | 25MB03567400 | 207R00000X |
NH | LT-2676 | 207R00000X |
NH | T-0332 | 207R00000X |
NH | 14054 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NH | 30226389 | Medicaid | |
NJ | 1519107 | Medicaid | |
NJ | 1519107 | Medicaid | |
NJ | 458480A0B | Medicare PIN | |
C58619 | Medicare UPIN |