Provider Demographics
NPI:1245370154
Name:PANAGIOTIS ZENETOS PHYSICIAN, PC
Entity type:Organization
Organization Name:PANAGIOTIS ZENETOS PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PANAGIOTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ZENETOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-224-9094
Mailing Address - Street 1:21633 27TH AVE
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-2611
Mailing Address - Country:US
Mailing Address - Phone:718-224-9094
Mailing Address - Fax:718-726-1084
Practice Address - Street 1:21633 27TH AVE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11360-2611
Practice Address - Country:US
Practice Address - Phone:718-224-9094
Practice Address - Fax:718-726-1084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08090Medicare PIN
NYA100001022Medicare PIN