Provider Demographics
NPI:1376704007
Name:SUSAN E.PANES, D.O. P.C.
Entity Type:Organization
Organization Name:SUSAN E.PANES, D.O. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:PANES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-428-4748
Mailing Address - Street 1:222 WESTCHESTER AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2906
Mailing Address - Country:US
Mailing Address - Phone:914-428-4748
Mailing Address - Fax:914-946-8766
Practice Address - Street 1:222 WESTCHESTER AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-2906
Practice Address - Country:US
Practice Address - Phone:914-428-4748
Practice Address - Fax:914-946-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183672207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG87278Medicare UPIN