Provider Demographics
NPI:1346365665
Name:PANSKY, JONATHAN HUGH (PHD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:HUGH
Last Name:PANSKY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 SECOR RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4234
Mailing Address - Country:US
Mailing Address - Phone:419-475-4449
Mailing Address - Fax:419-479-3230
Practice Address - Street 1:4334 SECOR RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4234
Practice Address - Country:US
Practice Address - Phone:419-475-4449
Practice Address - Fax:419-479-3230
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4488103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
02104OtherPARAMOUNT HEALTH CARE
02104OtherPARAMOUNT HEALTH CARE
OHPACP11292Medicare ID - Type Unspecified