Provider Demographics
NPI:1134504376
Name:R JOUDEH MEDICAL PAVILION, PLLC
Entity Type:Organization
Organization Name:R JOUDEH MEDICAL PAVILION, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAMSEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUDEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-491-2003
Mailing Address - Street 1:466 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-5906
Mailing Address - Country:US
Mailing Address - Phone:718-491-2003
Mailing Address - Fax:718-491-2007
Practice Address - Street 1:466 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-5906
Practice Address - Country:US
Practice Address - Phone:718-491-2003
Practice Address - Fax:718-491-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276139207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty