Provider Demographics
NPI:1790871507
Name:PANZER, PAULA G (MD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:G
Last Name:PANZER
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 1:142 W END AVE
Mailing Address - Street 2:SUITE 1S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6103
Mailing Address - Country:US
Mailing Address - Phone:212-799-8016
Mailing Address - Fax:
Practice Address - Street 1:142 WEST END AVENUE
Practice Address - Street 2:SUITE 1S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6103
Practice Address - Country:US
Practice Address - Phone:212-799-8016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1800982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY63K691Medicare ID - Type Unspecified
NYF30376Medicare UPIN