1689664773 NPI number — JAYNE PAVLAK-SCHENK DO

Table of content: JAYNE PAVLAK-SCHENK DO (NPI 1689664773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689664773 NPI number — JAYNE PAVLAK-SCHENK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAVLAK-SCHENK
Provider First Name:
JAYNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689664773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1608 ROUTE 88 W
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
BRICK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08724-3009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-840-8880
Provider Business Mailing Address Fax Number:
732-840-3939

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1608 ROUTE 88 W
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
BRICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08724-3009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-840-8880
Provider Business Practice Location Address Fax Number:
732-840-3939
Provider Enumeration Date:
10/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  25MB04677600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 040046776NJ01 . This is a "ANTHEM" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 112402 . This is a "CHN" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 38470 . This is a "MASTERCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 5042801 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3819175002 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 6101430 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2337434 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 830006946 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 855791 . This is a "EMPIRE HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 71679 . This is a "LOCAL 825" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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