Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 225974 | NY |
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 35086210 | OH |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | A110395 | CA |
NPI | 1053405712 |
---|---|
Provider Name | Paula A Lidestri |
First Address | Watertown, NY 13601 |
Second Address | Palm Springs, CA 92262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 23/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
136199 | (02) | OH |
2572603 | (05) | OH |