1942337316 NPI number — DOMINICK F. PAONESSA, MD PC

Table of content: (NPI 1942337316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942337316 NPI number — DOMINICK F. PAONESSA, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOMINICK F. PAONESSA, MD PC
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:
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:
1942337316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
319 S MANNING BLVD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208-1742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-489-2651
Provider Business Mailing Address Fax Number:
518-459-2928

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
319 S MANNING BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208-1742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-489-2651
Provider Business Practice Location Address Fax Number:
518-459-2928
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MEISTER
Authorized Official First Name:
ANN
Authorized Official Middle Name:
Authorized Official Title or Position:
INSURANCE COORDINATOR
Authorized Official Telephone Number:
518-489-2651

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  109356 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00315251 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000405889002 . This is a "BLUE SHIELD OF NENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 04543 . This is a "GHI HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 28331 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 04132 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0014904 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 040005885 . This is a "RR MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10001547 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 104543 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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