Healthcare Provider Details

I. General information

NPI: 1376506972
Provider Name (Legal Business Name): JANICE M PAVIS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 07/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1368 CLOVE RD
STATEN ISLAND NY
10301-4303
US

IV. Provider business mailing address

1368 CLOVE RD
STATEN ISLAND NY
10301-4303
US

V. Phone/Fax

Practice location:
  • Phone: 718-447-1183
  • Fax: 718-447-7252
Mailing address:
  • Phone: 718-447-1183
  • Fax: 718-447-7252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number216379
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number216379
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: