Provider Demographics
NPI:1548200967
Name:ZENETOS, PANAGIOTIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PANAGIOTIS
Middle Name:
Last Name:ZENETOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21633 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2611
Mailing Address - Country:US
Mailing Address - Phone:718-224-9094
Mailing Address - Fax:718-631-3043
Practice Address - Street 1:21633 27TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2611
Practice Address - Country:US
Practice Address - Phone:718-224-9094
Practice Address - Fax:718-631-3043
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2009-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235075-4207L00000X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020476700006Medicaid
NY020476700008Medicaid
NY020476700011Medicaid
NY020476700005Medicaid
NY020476700007Medicaid
NY020476700001Medicaid
NY020476700010Medicaid
NY020476700004Medicaid
NY36B25EX061Medicare PIN
NY08090GMedicare PIN
NY020476700006Medicaid