Provider Demographics
NPI:1811032519
Name:POPE JOHN II PAVILLION
Entity Type:Organization
Organization Name:POPE JOHN II PAVILLION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:CHAVIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-567-0400
Mailing Address - Street 1:170 53RD STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLNY
Mailing Address - State:NY
Mailing Address - Zip Code:11322
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:135 S CENTER ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07050-3522
Practice Address - Country:US
Practice Address - Phone:973-266-3302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
315352Medicare Oscar/Certification