Provider Demographics
NPI:1528471448
Name:VALESTRA, PAUL KRISTAN (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL KRISTAN
Middle Name:
Last Name:VALESTRA
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 1:1200 E RIDGEWOOD AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3937
Mailing Address - Country:US
Mailing Address - Phone:201-689-7755
Mailing Address - Fax:201-689-0521
Practice Address - Street 1:1200 E RIDGEWOOD AVE STE 303
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3937
Practice Address - Country:US
Practice Address - Phone:201-689-7755
Practice Address - Fax:201-689-0521
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10819600207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty