Provider Demographics
NPI:1083701155
Name:PANAGOS, ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:
Last Name:PANAGOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 2ND AVE
Mailing Address - Street 2:SUITE 6D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017-4504
Mailing Address - Country:US
Mailing Address - Phone:347-404-5122
Mailing Address - Fax:347-332-1192
Practice Address - Street 1:820 2ND AVE
Practice Address - Street 2:SUITE 6D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-4504
Practice Address - Country:US
Practice Address - Phone:347-404-5122
Practice Address - Fax:347-332-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228647208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation