Basic Information
| Provider Information | |||||||||
| NPI: | 1003294091 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | MARIA NIDEA | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 20301 33RD AVE | ||||||||
| Address2: | |||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113611025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3478064173 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 20301 33RD AVE | ||||||||
| Address2: | |||||||||
| City: | BAYSIDE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113611025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3478064173 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2015 | ||||||||
| LastUpdateDate: | 05/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 252Y00000X | 008647-1 | NY | Y | Agencies | Early Intervention Provider Agency |
No ID Information.