| Pavonia Gastroenterology Llc | |
|
600 Pavonia Avenue 3rd Floor Jersey City NJ 07306 | |
| (201) 216-3065 | |
| (201) 499-0250 |
| Full Name | Pavonia Gastroenterology Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 600 Pavonia Avenue, Jersey City, New Jersey |
| Authorized Official Name and Position | Paul M Stoopack (PRESIDENT) |
| Authorized Official Contact | 2012163065 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pavonia Gastroenterology Llc Po Box 8168 Fdr Station New York NY 10150 Ph: (201) 216-3065 | Pavonia Gastroenterology Llc 600 Pavonia Avenue 3rd Floor Jersey City NJ 07306 Ph: (201) 216-3065 |
| NPI Number | 1508071002 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4486839545 |
|---|---|
| Medicare Enrollment ID | O20110505000066 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508071002 | NPI | - | NPPES |
| 5037000 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | MA05631200 (New Jersey) | Primary |
| Provider Name | Paul M Stoopack |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1073509931 PECOS PAC ID: 7214938588 Enrollment ID: I20110505000113 |
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