Provider Demographics
NPI:1760802698
Name:PANICKER, HANOSH C
Entity Type:Individual
Prefix:MR
First Name:HANOSH
Middle Name:C
Last Name:PANICKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 BEAUMONT CIR
Mailing Address - Street 2:4
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1547
Mailing Address - Country:US
Mailing Address - Phone:914-202-8816
Mailing Address - Fax:
Practice Address - Street 1:31 BEAUMONT CIR
Practice Address - Street 2:4
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1547
Practice Address - Country:US
Practice Address - Phone:914-202-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WV0202XOther Service ProvidersContractorVehicle Modifications
No172A00000XOther Service ProvidersDriver