Provider Demographics
NPI:1053748178
Name:PASCHALIDIS, MARIA (DO)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PASCHALIDIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 KENNEDY BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-2468
Mailing Address - Country:US
Mailing Address - Phone:201-520-7474
Mailing Address - Fax:201-864-1485
Practice Address - Street 1:3196 KENNEDY BLVD STE 3
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-2468
Practice Address - Country:US
Practice Address - Phone:201-520-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285933207Q00000X
NJ390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program