1225019649 NPI number — J PAONESSA MD PA

Table of content: (NPI 1225019649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225019649 NPI number — J PAONESSA MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J PAONESSA MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225019649
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 5TH AVENUE NORTH
Provider Second Line Business Mailing Address:
SUITE 505
Provider Business Mailing Address City Name:
ST. PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33705
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-821-0017
Provider Business Mailing Address Fax Number:
727-502-8861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 5TH AVENUE NORTH
Provider Second Line Business Practice Location Address:
SUITE 505
Provider Business Practice Location Address City Name:
ST. PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-821-0017
Provider Business Practice Location Address Fax Number:
727-895-0328
Provider Enumeration Date:
11/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRYSTAK
Authorized Official First Name:
MARULYN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
727-821-0017

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 376230100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com