Basic Information
| Provider Information | |||||||||
| NPI: | 1760666507 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PATERNO | ||||||||
| FirstName: | FLAVIO | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 BERGEN ST RM 1205 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071073000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739720037 | ||||||||
| FaxNumber: | 9739720743 | ||||||||
| Practice Location | |||||||||
| Address1: | 140 BERGEN ST | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071032425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9739727218 | ||||||||
| FaxNumber: | 9739722988 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35099749 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 282N00000X | N | Hospitals | General Acute Care Hospital | 204F00000X | 35099749 | OH | Y | Allopathic & Osteopathic Physicians | Transplant Surgery |
No ID Information.