Provider Demographics
NPI:1376506972
Name:PAVIS, JANICE M (DO)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:M
Last Name:PAVIS
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 1:1368 CLOVE RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-4303
Mailing Address - Country:US
Mailing Address - Phone:718-447-1183
Mailing Address - Fax:718-447-7252
Practice Address - Street 1:1368 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-4303
Practice Address - Country:US
Practice Address - Phone:718-447-1183
Practice Address - Fax:718-447-7252
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2007-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216379208100000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
08970410Medicare ID - Type Unspecified
I21168Medicare UPIN