Basic Information
| Provider Information | |||||||||
| NPI: | 1447337761 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TRELA | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | HENRY | ||||||||
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| Credential: | F.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | PHYSICAL MEDICINE & REHABILIATION | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645820 | ||||||||
| FaxNumber: | 3154648699 | ||||||||
| Practice Location | |||||||||
| Address1: | 750 E ADAMS ST | ||||||||
| Address2: | PHYSICAL MEDICINE & REHABILIATION | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132102342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154645820 | ||||||||
| FaxNumber: | 3154648699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 08/21/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F332727 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 02328949 | 05 | NY | MEDICAID |