1053654533 NPI number — JULIA SHELKEY PAVELIC M.D.

Table of content: JULIA SHELKEY PAVELIC M.D. (NPI 1053654533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053654533 NPI number — JULIA SHELKEY PAVELIC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAVELIC
Provider First Name:
JULIA
Provider Middle Name:
SHELKEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHELKEY
Provider Other First Name:
JULIA
Provider Other Middle Name:
ALLISON
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1053654533
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
622 W 168TH ST
Provider Second Line Business Mailing Address:
PH5-133 STEM, CUMC DEPT OF ANESTHESIOLOGY
Provider Business Mailing Address City Name:
NEW YORK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10032-3720
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-627-9697
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 DIAMOND HILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERKELEY HEIGHTS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
908-277-8872
Provider Business Practice Location Address Fax Number:
908-673-7382
Provider Enumeration Date:
04/03/2013

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: 25MA10262800 , 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)





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