Provider Demographics
NPI:1184717266
Name:PANARAM, DHANWANTI (DIETITIAN)
Entity type:Individual
Prefix:
First Name:DHANWANTI
Middle Name:
Last Name:PANARAM
Suffix:
Gender:F
Credentials:DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 HUNTINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1944
Mailing Address - Country:US
Mailing Address - Phone:718-684-7742
Mailing Address - Fax:917-575-8456
Practice Address - Street 1:1024 HUNTINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1944
Practice Address - Country:US
Practice Address - Phone:718-684-7742
Practice Address - Fax:718-684-7742
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005898133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY9390E1Medicare ID - Type Unspecified