Provider Demographics
NPI:1790769487
Name:PAVELL, JEFF RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:RICHARD
Last Name:PAVELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4967
Mailing Address - Country:US
Mailing Address - Phone:201-567-2277
Mailing Address - Fax:201-567-7506
Practice Address - Street 1:365 ROUTE 304
Practice Address - Street 2:STE 102
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1601
Practice Address - Country:US
Practice Address - Phone:845-624-2182
Practice Address - Fax:845-624-2188
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202584208100000X
NJMB69881208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ804550Medicaid
NJDO7698000OtherCDS
NY8P5694143OtherDEA
NJ8P6614994OtherDEA
526907Medicare ID - Type Unspecified