Provider Demographics
NPI:1649269853
Name:PALADINO, THERESA ANN (DO)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:ANN
Last Name:PALADINO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 BROAD ST
Mailing Address - Street 2:MONMOUTH PEDIATRIC GROUP
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2003
Mailing Address - Country:US
Mailing Address - Phone:732-741-0456
Mailing Address - Fax:
Practice Address - Street 1:272 BROAD ST
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2003
Practice Address - Country:US
Practice Address - Phone:732-741-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07376800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0039781Medicaid