Provider Demographics
NPI:1679063572
Name:NEIL B PAULVIN DOCTOR OF OSTEOPATHIC MEDICINE
Entity Type:Organization
Organization Name:NEIL B PAULVIN DOCTOR OF OSTEOPATHIC MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:732-407-9834
Mailing Address - Street 1:245 E 40TH ST APT 26C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-1718
Mailing Address - Country:US
Mailing Address - Phone:732-407-9834
Mailing Address - Fax:646-930-2027
Practice Address - Street 1:400 W MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3009
Practice Address - Country:US
Practice Address - Phone:646-828-7844
Practice Address - Fax:646-930-2027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty