Provider Demographics
NPI:1386818474
Name:CAGLE, PAUL JOSEPH JR (MD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:JOSEPH
Last Name:CAGLE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1000 10TH AVE
Mailing Address - Street 2:SUITE 3A35
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1147
Mailing Address - Country:US
Mailing Address - Phone:212-523-7584
Mailing Address - Fax:212-636-3102
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:SUITE 3A35
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-7584
Practice Address - Fax:212-636-3102
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-135794207X00000X
NY269632207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036135794Medicaid
ILF400159295Medicare PIN