Provider Demographics
NPI:1871208843
Name:PAFF, FREDERICK MICHAEL JR (LAC)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:MICHAEL
Last Name:PAFF
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-2004
Mailing Address - Country:US
Mailing Address - Phone:201-989-9304
Mailing Address - Fax:
Practice Address - Street 1:65 STATE RT 4
Practice Address - Street 2:
Practice Address - City:RIVER EDGE
Practice Address - State:NJ
Practice Address - Zip Code:07661-1949
Practice Address - Country:US
Practice Address - Phone:201-989-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00147600171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist