Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 25MB08808500 | NJ |
NPI | 1477780369 |
---|---|
Provider Name | Dr. Reynaldo S Paraiso JR. |
First Address | West Orange, NJ 07052-1174 |
Second Address | West Orange, NJ 07052-1174 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2009 |
Last Update Date | 20/01/2011 |