Provider Demographics
NPI:1285779900
Name:PAUL, JEFFREY T (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:PAUL
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 1:414 MAPLE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5533
Mailing Address - Country:US
Mailing Address - Phone:518-587-0772
Mailing Address - Fax:
Practice Address - Street 1:414 MAPLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5533
Practice Address - Country:US
Practice Address - Phone:518-587-0772
Practice Address - Fax:518-587-8749
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168882-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00996745Medicaid
NY54247BMedicare PIN
NY54247AMedicare PIN
NYW53373Medicare UPIN
NYA03023Medicare UPIN