Provider Demographics
NPI:1710083217
Name:PANG LAY KOOI , P.C.
Entity Type:Organization
Organization Name:PANG LAY KOOI , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANG
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOOI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-252-8800
Mailing Address - Street 1:195 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3302
Mailing Address - Country:US
Mailing Address - Phone:315-252-8800
Mailing Address - Fax:315-258-3938
Practice Address - Street 1:195 GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3302
Practice Address - Country:US
Practice Address - Phone:315-252-8800
Practice Address - Fax:315-258-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125447-1302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00457043Medicaid
NYB81629Medicare UPIN
NYJ100000155Medicare PIN
NY37018BMedicare ID - Type UnspecifiedMEDICARE