Provider Demographics
NPI:1104900844
Name:ITTOOP, PAUL T (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:T
Last Name:ITTOOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 PALISADE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-4429
Mailing Address - Country:US
Mailing Address - Phone:201-863-4547
Mailing Address - Fax:973-316-0459
Practice Address - Street 1:2001 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-4429
Practice Address - Country:US
Practice Address - Phone:201-863-4547
Practice Address - Fax:973-316-0459
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO3862600207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3461203Medicaid
NJC56685Medicare UPIN
NJ3461203Medicaid