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General NPI Number Information
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NPI Number | 1407028657
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Entity Type | Organization
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Legal Business Name | ALEX R PAVON MD PC
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 106 W PALISADE AVE SUITE 101
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-2633
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Country | US
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Telephone | 201-503-1000
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Fax | 201-568-4300
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Provider Business Mailing Address
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Address Line | PO BOX 5917
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City | ENGLEWOOD
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State | NJ
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Zip | 07631-5917
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Country | US
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Telephone | 201-568-6200
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Fax | 201-568-4300
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Authorized Official
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Title or Position | OWNER
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Name | ALEX RODRIGO PAVON
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Credential | M.D.
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Telephone | 201-503-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 25MA07135200
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License Number State | NJ
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