Provider Demographics
NPI:1134265978
Name:PANEK, WILLIAM N (DPM)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:N
Last Name:PANEK
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 1:13104 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:ALDEN
Mailing Address - State:NY
Mailing Address - Zip Code:14004-1233
Mailing Address - Country:US
Mailing Address - Phone:716-937-3310
Mailing Address - Fax:716-937-4624
Practice Address - Street 1:13104 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:ALDEN
Practice Address - State:NY
Practice Address - Zip Code:14004-1233
Practice Address - Country:US
Practice Address - Phone:716-937-3310
Practice Address - Fax:716-937-4624
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003785-1213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0061529OtherGHI
NY000500510001OtherBLUE CROSS AND SHIELD
NY0061529OtherGHI
NY000500510001OtherBLUE CROSS AND SHIELD