MEDICARE: POPE JOHN II PAVILLION

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1811032519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	POPE JOHN II PAVILLION

Provider Business Mailing Address
First Line	:	170 53RD STREET
Second Line	:
City	:	BROOKLNY
State	:	NY
Zip	:	11322
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 S CENTER ST
Second Line	:
City	:	ORANGE
State	:	NJ
Zip	:	07050-3522
Country	:	US
Telephone Number	:	973-266-3302
Fax Number	:

Authorized Official
Title or Position	:	BILLING SUPERVISOR
Name	:	CHAVIE KATZ
Credential	:
Telephone Number	:	718-567-0400

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	01/08/2008

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Directions to “POPE JOHN II PAVILLION ” Practice Location

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