Provider Demographics
NPI:1851699946
Name:PANDA MEDICAL PC
Entity Type:Organization
Organization Name:PANDA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SREE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-482-8824
Mailing Address - Street 1:340 MONTAUK HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4437
Mailing Address - Country:US
Mailing Address - Phone:631-482-8824
Mailing Address - Fax:631-482-8827
Practice Address - Street 1:340 MONTAUK HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4437
Practice Address - Country:US
Practice Address - Phone:631-482-8824
Practice Address - Fax:631-482-8827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253322208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty