Provider Demographics
NPI:1689972002
Name:PAVILION MEDICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:PAVILION MEDICAL ASSOCIATES, LLC
Other - Org Name:PAVILION MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:RAJNEY
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:BAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-616-3761
Mailing Address - Street 1:25 ZEV CT
Mailing Address - Street 2:
Mailing Address - City:MONMOUTH JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08852-3128
Mailing Address - Country:US
Mailing Address - Phone:732-673-8011
Mailing Address - Fax:732-741-0337
Practice Address - Street 1:357 APPLEGARTH RD STE 11
Practice Address - Street 2:
Practice Address - City:MONROE TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08831-3731
Practice Address - Country:US
Practice Address - Phone:609-409-2400
Practice Address - Fax:609-409-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA066040800207R00000X
NJ25MA060109200207R00000X
NJ25MA06109200207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty