Provider Demographics
NPI:1013918846
Name:PANVINI, RICHARD (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:PANVINI
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MCLANE DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5509
Mailing Address - Country:US
Mailing Address - Phone:631-595-1511
Mailing Address - Fax:631-595-1511
Practice Address - Street 1:2 MCLANE DR
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-5509
Practice Address - Country:US
Practice Address - Phone:631-595-1511
Practice Address - Fax:631-595-1511
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2010-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004421213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01182329Medicaid
NY5835250001Medicare NSC
NYT83578Medicare UPIN
NY01182329Medicaid
NYP52192Medicare PIN