Provider Demographics
NPI:1578507323
Name:STRONG PANORAMA INTERNAL MEDICINE
Entity Type:Organization
Organization Name:STRONG PANORAMA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR FINANCE & ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAIBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-273-4607
Mailing Address - Street 1:2212 PENFIELD ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-1753
Mailing Address - Country:US
Mailing Address - Phone:585-598-8565
Mailing Address - Fax:585-388-6393
Practice Address - Street 1:2212 PENFIELD ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-1753
Practice Address - Country:US
Practice Address - Phone:585-598-8565
Practice Address - Fax:585-388-6393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0774Medicare ID - Type Unspecified