Provider Demographics
NPI:1437484003
Name:PANGAN, JANCYRUS RAYMUNDO (DPT)
Entity Type:Individual
Prefix:DR
First Name:JANCYRUS
Middle Name:RAYMUNDO
Last Name:PANGAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 MIDLAND AVE
Mailing Address - Street 2:6K
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-6465
Mailing Address - Country:US
Mailing Address - Phone:516-695-2599
Mailing Address - Fax:
Practice Address - Street 1:1 SCHOOL ST
Practice Address - Street 2:105A
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2545
Practice Address - Country:US
Practice Address - Phone:516-656-4824
Practice Address - Fax:516-656-4833
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist