Provider Demographics
NPI:1285977256
Name:THERATTIL, PAUL JAI (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JAI
Last Name:THERATTIL
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 1:211 WOODBINE CIR
Mailing Address - Street 2:
Mailing Address - City:NEW PROVIDENCE
Mailing Address - State:NJ
Mailing Address - Zip Code:07974-1737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:201-603-1993
Practice Address - Street 1:113 W ESSEX ST STE 202
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07607-1023
Practice Address - Country:US
Practice Address - Phone:973-972-8092
Practice Address - Fax:201-603-1993
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10358100208200000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program