Provider Demographics
NPI:1720823453
Name:PAUL, EUNICE (SPECIAL ED TEACHER)
Entity type:Individual
Prefix:
First Name:EUNICE
Middle Name:
Last Name:PAUL
Suffix:
Gender:F
Credentials:SPECIAL ED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1263 ELDER AVE PH
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472-2304
Mailing Address - Country:US
Mailing Address - Phone:718-902-7704
Mailing Address - Fax:
Practice Address - Street 1:6214 RIVERDALE AVE STE 1A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-1032
Practice Address - Country:US
Practice Address - Phone:718-701-4807
Practice Address - Fax:718-701-4806
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1804969241225500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistGroup - Single Specialty