Provider Demographics
NPI:1619240165
Name:JILL P KAVALER MD PC
Entity Type:Organization
Organization Name:JILL P KAVALER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:P
Authorized Official - Last Name:KAVALER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-767-2123
Mailing Address - Street 1:11 BOGERT RD
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627-1201
Mailing Address - Country:US
Mailing Address - Phone:201-767-2123
Mailing Address - Fax:201-750-8610
Practice Address - Street 1:68 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1012
Practice Address - Country:US
Practice Address - Phone:201-767-2123
Practice Address - Fax:718-994-9682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193398207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty