Provider Demographics
NPI:1306831706
Name:PANES, SUSAN ELLEN (DO)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELLEN
Last Name:PANES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 HOLLOW LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11042-1215
Mailing Address - Country:US
Mailing Address - Phone:516-365-6666
Mailing Address - Fax:516-365-2183
Practice Address - Street 1:32 VILLAGE SQ
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2515
Practice Address - Country:US
Practice Address - Phone:516-676-1111
Practice Address - Fax:516-676-1366
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183672207K00000X, 207KA0200X, 207KI0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207KI0005XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2C0754OtherHEALTHNET
NY5605676OtherAETNA US HEALTHCARE
NY01454HOtherGHI MEDICARE
NY6100677OtherGHI
NY183673OtherHIP
NY0447024006OtherCIGNA
NY1118556OtherUNITED HEALTHCARE
NY1049295OtherFIRST HEALTH
NY90553OtherVYTRA
NY95G741OtherBLUE CROSS BLUE SHIELD
NYON13091OtherMDNY
NYP1107530OtherOXFORD
NY5605676OtherAETNA US HEALTHCARE
NYP1107530OtherOXFORD