=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205845229
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL NICOLAE PAVEL P.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 HAMILTON DR W
-----------------------------------------------------
City | NORTH CALDWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07006-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-226-4588
-----------------------------------------------------
Fax | 973-226-5368
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 HAMILTON DR W
-----------------------------------------------------
City | NORTH CALDWELL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07006-4611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-226-4588
-----------------------------------------------------
Fax | 973-226-5368
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251X0800X
-----------------------------------------------------
Taxonomy Name | Orthopedic Physical Therapist
-----------------------------------------------------
License Number | 40QA00147700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------