Provider Demographics
NPI:1407028657
Name:ALEX R PAVON MD PC
Entity Type:Organization
Organization Name:ALEX R PAVON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:RODRIGO
Authorized Official - Last Name:PAVON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-503-1000
Mailing Address - Street 1:PO BOX 5917
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-5917
Mailing Address - Country:US
Mailing Address - Phone:201-568-6200
Mailing Address - Fax:201-568-4300
Practice Address - Street 1:106 W PALISADE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2633
Practice Address - Country:US
Practice Address - Phone:201-503-1000
Practice Address - Fax:201-568-4300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07135200261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ098611Medicare PIN
G21738Medicare UPIN