Provider Demographics
NPI:1871600510
Name:SIDOTI, PAUL A (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:A
Last Name:SIDOTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:310 EAST 14TH STREET
Mailing Address - Street 2:SUITE 319S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-979-4590
Mailing Address - Fax:212-979-4512
Practice Address - Street 1:310 EAST 14TH STREET
Practice Address - Street 2:SUITE 319S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-979-4590
Practice Address - Fax:212-979-4512
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2013-01-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY179585207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01496340Medicaid
NY01K751Medicare ID - Type Unspecified
NY01496340Medicaid