Provider Demographics
NPI:1174530828
Name:PRAINO, THOMAS D (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:D
Last Name:PRAINO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:1 DEGRAW AVENUE
Mailing Address - Street 2:NJOS
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-353-9000
Mailing Address - Fax:201-530-0003
Practice Address - Street 1:1 DEGRAW AVENUE
Practice Address - Street 2:NORTH JERSEY ORTHOPAEDIC SPECIALISTS
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-353-9000
Practice Address - Fax:201-530-0003
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00153200363A00000X
NY010725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant