Provider Demographics
NPI:1831593367
Name:PAUL, EARVIN JOHNSON
Entity type:Individual
Prefix:
First Name:EARVIN
Middle Name:JOHNSON
Last Name:PAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WILLIAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3006
Mailing Address - Country:US
Mailing Address - Phone:845-709-3281
Mailing Address - Fax:
Practice Address - Street 1:30 WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3006
Practice Address - Country:US
Practice Address - Phone:845-709-3281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program