NPIMap

Individual provider Active NPI

Theophanis A Pavlou, MD

  • Pulmonary Disease Physician
  • Englewood, NJ
National Provider Identifier
1871552026
Registry record updated Nov 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
MA59211 Issued in NJ
Practice address
200 Grand Ave
Suite 102
Englewood, NJ 07631-4363
Phone
(201) 871-3636
Fax
(201) 871-2286
NPI assigned
Mar 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X MA59211 NJ Primary

Addresses

Primary practice location

200 Grand Ave
Suite 102
Englewood, NJ 07631-4363

Mailing address

200 Grand Ave
Suite 102
Englewood, NJ 07631-4363
Phone (201) 871-3636

Other identifiers 1

IdentifierTypeStateIssuer
6341705MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090826000099 NJ Practitioner - Pulmonary DiseasePractitioner - General PracticePractitioner - Internal MedicinePractitioner - Critical Care (Intensivists)Practitioner - Sleep Medicine 0143375279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists), Internal Medicine, Sleep Medicine
Education
New York Medical College, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Holy Name Pulmonary Associates PCGroup PAC ID 2466514674, 15 clinicians

Practice addresses (Care Compare)

200 Grand Ave
Suite 102
Englewood, NJ 07631-4363
Phone (201) 871-3636

718 Teaneck Rd
Teaneck, NJ 07666-4245
Phone 20183330007405

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MA59211NJMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Holy Name Pulmonary Associates, PC Pulmonary Disease CurrentSince Mar 20, 2012 Accepting new patients
Pulmonary Associates of Northern New Jersey P a Pulmonary Disease Current Accepting new patients

Locations

200 Grand Ave
Ste 102
Englewood, NJ 07631
Phone (201) 481-7160

8305 Bergenline Ave
Ste A
North Bergen, NJ 07047
Phone (201) 854-7200

718 Teaneck Rd
#L1
Teaneck, NJ 07666
Phone (201) 837-8282

718 Teaneck Rd
Teaneck, NJ 07666
Phone (201) 833-3232

Organizations & group practices 2

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320624000000",
    "number": "1871552026",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GRAND AVE",
            "address_2": "SUITE 102",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314363",
            "telephone_number": "201-871-3636",
            "fax_number": "201-871-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GRAND AVE",
            "address_2": "SUITE 102",
            "city": "ENGLEWOOD",
            "state": "NJ",
            "postal_code": "076314363",
            "telephone_number": "201-871-3636",
            "fax_number": "201-871-2286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAVLOU",
        "first_name": "THEOPHANIS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-17",
        "last_updated": "2011-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NJ",
            "license": "MA59211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6341705",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Englewood, NJ

Sources for this page

Verify at the official NPI Registry.