Provider Demographics
NPI:1023302999
Name:PADERON, JOSE ARNOLDO BUENDIA (OT)
Entity type:Individual
Prefix:
First Name:JOSE ARNOLDO
Middle Name:BUENDIA
Last Name:PADERON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 VASSAR DR
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-5360
Mailing Address - Country:US
Mailing Address - Phone:732-607-0094
Mailing Address - Fax:
Practice Address - Street 1:200 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1219
Practice Address - Country:US
Practice Address - Phone:718-448-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016405-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist