Provider Demographics
NPI:1295754158
Name:HRISO, PAUL A (MD PA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:HRISO
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 MATTHEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2622
Mailing Address - Country:US
Mailing Address - Phone:201-437-1775
Mailing Address - Fax:201-436-1601
Practice Address - Street 1:354 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1412
Practice Address - Country:US
Practice Address - Phone:201-437-1775
Practice Address - Fax:201-436-1601
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA590332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6903801Medicaid
NJG19743Medicare UPIN
NJ818173Medicare ID - Type Unspecified