Provider Demographics
NPI:1821471657
Name:PANSHERIA, MALAY (OD)
Entity Type:Individual
Prefix:DR
First Name:MALAY
Middle Name:
Last Name:PANSHERIA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08401-8006
Mailing Address - Country:US
Mailing Address - Phone:609-345-3000
Mailing Address - Fax:
Practice Address - Street 1:1440 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:NJ
Practice Address - Zip Code:08401-8006
Practice Address - Country:US
Practice Address - Phone:609-345-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3738-35152W00000X
COOPT.0003740152W00000X
MTOPT-OPT-LIC-4556152W00000X
VA0618003065152W00000X
NJ27OA00659800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist