Provider Demographics
NPI:1659799401
Name:PANGANIBAN, MARIE KRISTINE NUFABLE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE KRISTINE
Middle Name:NUFABLE
Last Name:PANGANIBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:688 WHITE PLAINS RD STE 224
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5015
Mailing Address - Country:US
Mailing Address - Phone:914-725-5556
Mailing Address - Fax:914-725-5597
Practice Address - Street 1:688 WHITE PLAINS RD STE 224
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5015
Practice Address - Country:US
Practice Address - Phone:914-725-5556
Practice Address - Fax:914-725-5597
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-30
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295313207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty