Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3940 | NY |
NPI | 1619064680 |
---|---|
Provider Name | Dr. Steven J Pavia |
First Address | Monroe, NY 10950-1608 |
Second Address | Monroe, NY 10950-1608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2006 |
Last Update Date | 08/07/2007 |