Provider Demographics
NPI:1649285594
Name:PAUL HRISO MD PA
Entity type:Organization
Organization Name:PAUL HRISO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HRISO
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:201-437-1775
Mailing Address - Street 1:100 MATTHEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:BEDMINSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07921-2622
Mailing Address - Country:US
Mailing Address - Phone:201-436-4080
Mailing Address - Fax:201-436-1601
Practice Address - Street 1:354 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1412
Practice Address - Country:US
Practice Address - Phone:201-437-1775
Practice Address - Fax:201-436-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6903801Medicaid
NJ6903801Medicaid
NJG19743Medicare UPIN