Provider Demographics
NPI:1225017536
Name:PAN, ENG MEE MOONG MARILYN (CNM)
Entity Type:Individual
Prefix:MS
First Name:ENG MEE MOONG
Middle Name:MARILYN
Last Name:PAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:48 MARKET ST
Mailing Address - Street 2:2M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-8400
Mailing Address - Country:US
Mailing Address - Phone:212-766-9751
Mailing Address - Fax:212-766-1158
Practice Address - Street 1:48 MARKET ST
Practice Address - Street 2:2M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-8400
Practice Address - Country:US
Practice Address - Phone:212-766-9751
Practice Address - Fax:212-766-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2016-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF000340367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01944509Medicaid
NY01944509Medicaid