Provider Demographics
NPI:1972566719
Name:PANGILINAN, AUDWIN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:AUDWIN
Middle Name:JOSEPH
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 RIDGEWAY AVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4296
Mailing Address - Country:US
Mailing Address - Phone:585-723-7060
Mailing Address - Fax:585-723-7325
Practice Address - Street 1:2655 RIDGEWAY AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-723-7060
Practice Address - Fax:585-723-7325
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1977972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154396Medicaid
NYA400011894/70008AMedicare PIN
NY02154396Medicaid