Suzanne Pavelock

Primary specialty

Developmentally Disabled Services Day Training AgencyTaxonomy code 251C00000X

License

827294 Issued in NY

Practice address

90 Airpark Drive
Ronkonkoma, NY 11779

Phone

(631) 580-4001

NPI assigned

Jun 25, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ddi

  • Case Management Agency
  • Ronkonkoma, NY
  • NPI 1437584562
  NPD (past)
• Developmental Disabilities Institute

  • Early Intervention Provider Agency
  • Ronkonkoma, NY
  • NPI 1215207162
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1403654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1740695097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 STUYVESANT DR",
            "city": "SELDEN",
            "state": "NY",
            "postal_code": "117841225",
            "telephone_number": "631-335-4239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 AIRPARK DRIVE",
            "city": "RONKONKOMA",
            "state": "NY",
            "postal_code": "11779",
            "telephone_number": "631-580-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVELOCK",
        "first_name": "SUZANNE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-25",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NY",
            "license": "827294",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christopher Joseph Pastorelli
• Shail Patel, PT
• Melissa Patterson
• Paul D Priolo DC PC
• Melissa Ann Pavao-Callis, LMHC
• Sara Pearson, FNP
• Kelly Joy Pena, RN
• Jennifer Perez Mejia, M.A., CCC-SLP
• Barbara Perez, LMT
• Sonya Antoinette Perez, RN

• Developmentally Disabled Services Day Training Agency in Ronkonkoma, NY
• Providers in Ronkonkoma, NY by specialty
• Developmentally Disabled Services Day Training Agency in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.