Provider Demographics
NPI:1134608375
Name:PANNAZZO, THOMAS (RT)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:PANNAZZO
Suffix:
Gender:M
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 ROSE PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-5312
Mailing Address - Country:US
Mailing Address - Phone:866-711-1299
Mailing Address - Fax:
Practice Address - Street 1:50 ROSE PL
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-5312
Practice Address - Country:US
Practice Address - Phone:866-711-1299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic