Provider Demographics
NPI:1083880207
Name:PANVINI, RON (PHD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:PANVINI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W 73RD ST
Mailing Address - Street 2:6-I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3012
Mailing Address - Country:US
Mailing Address - Phone:212-595-4952
Mailing Address - Fax:212-595-4958
Practice Address - Street 1:160 W 73RD ST
Practice Address - Street 2:6-I
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3012
Practice Address - Country:US
Practice Address - Phone:212-595-4952
Practice Address - Fax:212-595-4958
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000976101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health