Provider Demographics
NPI:1093798928
Name:PANZARINO, PETER JOSEPH JR (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOSEPH
Last Name:PANZARINO
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:64 JEFFERSON STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MONTECELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1148
Mailing Address - Country:US
Mailing Address - Phone:845-791-8800
Mailing Address - Fax:845-791-7051
Practice Address - Street 1:2 HIGH ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1343
Practice Address - Country:US
Practice Address - Phone:845-791-8800
Practice Address - Fax:845-791-7051
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2255272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY157BU1Medicare ID - Type Unspecified
B72651Medicare UPIN
NYB72651Medicare UPIN