Provider Demographics
NPI:1962681973
Name:DE LEON, PAOLO J (COTA)
Entity Type:Individual
Prefix:
First Name:PAOLO
Middle Name:J
Last Name:DE LEON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 W 14TH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1317
Mailing Address - Country:US
Mailing Address - Phone:973-583-9371
Mailing Address - Fax:
Practice Address - Street 1:93 W 14TH ST FL 1
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1317
Practice Address - Country:US
Practice Address - Phone:973-583-9371
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007010224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant