MEDICARE: MR. ALEX R PAVON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	199925-1	NY
2	207R00000X	Internal Medicine Physician	25MA07135200	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01000776801	OTHER		AMERICHOICE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8224329	OTHER	NJ	GHI
4	3K3007	OTHER	NJ	HEALTHNET
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700819208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEX R PAVON M.D.

Provider Business Mailing Address
First Line	:	81 ERIE ST
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-3403
Country	:	US
Telephone Number	:	201-384-6306
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 W 135TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-8601
Country	:	US
Telephone Number	:	212-491-2300
Fax Number	:	212-491-2323

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	12/30/2015

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Directions to “ MR. ALEX R PAVON M.D.” Practice Location

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