Provider Demographics
NPI:1487852604
Name:PANHAT
Entity Type:Organization
Organization Name:PANHAT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:HATEF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:607-426-0275
Mailing Address - Street 1:417 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:PA
Mailing Address - Zip Code:18810-1817
Mailing Address - Country:US
Mailing Address - Phone:607-426-0275
Mailing Address - Fax:
Practice Address - Street 1:417 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:PA
Practice Address - Zip Code:18810-1817
Practice Address - Country:US
Practice Address - Phone:607-426-0275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004047L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6609790001Medicare NSC
PA074423Medicare PIN