Provider Demographics
NPI:1477780369
Name:PARAISO, REYNALDO S JR (DO)
Entity type:Individual
Prefix:DR
First Name:REYNALDO
Middle Name:S
Last Name:PARAISO
Suffix:JR
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 1:741 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1174
Mailing Address - Country:US
Mailing Address - Phone:973-243-0600
Mailing Address - Fax:973-243-0707
Practice Address - Street 1:741 NORTHFIELD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1174
Practice Address - Country:US
Practice Address - Phone:973-243-0600
Practice Address - Fax:973-243-0707
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08808500207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ620416Medicare PIN