Provider Demographics
NPI:1952857765
Name:PAN, KATHERINE (PA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8256 215TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1408
Mailing Address - Country:US
Mailing Address - Phone:917-923-3292
Mailing Address - Fax:
Practice Address - Street 1:525 E. 68TH STREET
Practice Address - Street 2:SUITE #325
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4885
Practice Address - Country:US
Practice Address - Phone:212-746-7576
Practice Address - Fax:212-746-8383
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical