Provider Demographics
NPI:1245700111
Name:PRANEVICIUS MEDICAL P.C.
Entity type:Organization
Organization Name:PRANEVICIUS MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDAS
Authorized Official - Middle Name:
Authorized Official - Last Name:PRANEVICIUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-769-7413
Mailing Address - Street 1:300 ALBANY ST APT 6E
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1452
Mailing Address - Country:US
Mailing Address - Phone:917-769-7413
Mailing Address - Fax:
Practice Address - Street 1:300 ALBANY ST APT 6E
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1452
Practice Address - Country:US
Practice Address - Phone:917-769-7413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-04
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02196436Medicaid