Provider Demographics
NPI:1710066543
Name:PANACEA MEDICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:PANACEA MEDICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DROR
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-617-1551
Mailing Address - Street 1:17625 UNION TPKE
Mailing Address - Street 2:SUITE 349
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11366-1515
Mailing Address - Country:US
Mailing Address - Phone:718-264-7310
Mailing Address - Fax:718-264-8412
Practice Address - Street 1:17625 UNION TPKE
Practice Address - Street 2:SUITE 349
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11366-1515
Practice Address - Country:US
Practice Address - Phone:646-330-4748
Practice Address - Fax:718-264-8412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherTAX ID