Provider Demographics
NPI:1326732215
Name:PANASUK, ALLISON (RN, BSN, CBC)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:PANASUK
Suffix:
Gender:F
Credentials:RN, BSN, CBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 MONTAUK HWY FL 5
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4927
Mailing Address - Country:US
Mailing Address - Phone:631-376-3901
Mailing Address - Fax:
Practice Address - Street 1:655 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1314
Practice Address - Country:US
Practice Address - Phone:631-376-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605964163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant