Provider Demographics
NPI:1497469860
Name:PANKO, JEFFREY M (RN)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:PANKO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-3622
Mailing Address - Country:US
Mailing Address - Phone:646-479-4522
Mailing Address - Fax:845-669-7320
Practice Address - Street 1:1036 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-3622
Practice Address - Country:US
Practice Address - Phone:646-479-4522
Practice Address - Fax:845-669-7320
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY684421163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health