Provider Demographics
NPI:1629108972
Name:PANAIA, ELLERY III (DC)
Entity Type:Individual
Prefix:DR
First Name:ELLERY
Middle Name:
Last Name:PANAIA
Suffix:III
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1299 BRACE ROAD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034
Mailing Address - Country:US
Mailing Address - Phone:856-795-2424
Mailing Address - Fax:856-795-2212
Practice Address - Street 1:1299 BRACE ROAD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034
Practice Address - Country:US
Practice Address - Phone:856-795-2424
Practice Address - Fax:856-795-2212
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00430300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2707432000OtherBCBS AMERI HEALTH
NJ0461651OtherAETNA
NJ2707432000OtherBCBS AMERI HEALTH
NJ120561VBYMedicare ID - Type Unspecified