Provider Demographics
NPI:1689606501
Name:PANARO, NICHOLAS (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:PANARO
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 1:664 STONELEIGH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3990
Mailing Address - Country:US
Mailing Address - Phone:845-278-8400
Mailing Address - Fax:845-278-4326
Practice Address - Street 1:664 STONELEIGH AVE STE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3990
Practice Address - Country:US
Practice Address - Phone:845-278-8400
Practice Address - Fax:845-278-4326
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT61173208VP0000X
NY193022174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY260051518OtherRAILROAD MEDICARE
NYP00017559OtherRAILROAD MEDICARE
NYWCJ511OtherMEDICARE
NY260051518OtherRAILROAD MEDICARE
NYG22372Medicare UPIN
NY4682510001Medicare NSC
NY4682510003Medicare NSC