Provider Demographics
NPI:1285679753
Name:PANTIG, ZENAIDA V (MD)
Entity Type:Individual
Prefix:DR
First Name:ZENAIDA
Middle Name:V
Last Name:PANTIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6865 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5263
Mailing Address - Country:US
Mailing Address - Phone:718-443-2149
Mailing Address - Fax:718-443-2149
Practice Address - Street 1:1323 GREENE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4901
Practice Address - Country:US
Practice Address - Phone:718-443-2149
Practice Address - Fax:718-443-2149
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115063174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0085333OtherGHI
NY00211243Medicaid