Provider Demographics
NPI:1689664773
Name:PAVLAK-SCHENK, JAYNE (DO)
Entity Type:Individual
Prefix:
First Name:JAYNE
Middle Name:
Last Name:PAVLAK-SCHENK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ROUTE 88 W
Mailing Address - Street 2:SUITE 250
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-3009
Mailing Address - Country:US
Mailing Address - Phone:732-840-8880
Mailing Address - Fax:732-840-3939
Practice Address - Street 1:1608 ROUTE 88 W
Practice Address - Street 2:SUITE 250
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08724-3009
Practice Address - Country:US
Practice Address - Phone:732-840-8880
Practice Address - Fax:732-840-3939
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB04677600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ040046776NJ01OtherANTHEM
NJ112402OtherCHN
NJ38470OtherMASTERCARE
NJ5042801Medicaid
NJ3819175002OtherCIGNA
NJ6101430OtherGHI
NJ2337434OtherAETNA
NJ830006946OtherMEDICARE RAILROAD
NJ855791OtherEMPIRE HEALTHCARE
NJ71679OtherLOCAL 825
NJ2337434OtherAETNA
NJ112402OtherCHN