Provider Demographics
NPI:1457548745
Name:PANCARE MEDICAL PC
Entity Type:Organization
Organization Name:PANCARE MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SILAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:NWAISHIENYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-610-8704
Mailing Address - Street 1:15915 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3935
Mailing Address - Country:US
Mailing Address - Phone:718-473-2005
Mailing Address - Fax:718-523-2311
Practice Address - Street 1:15915 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3935
Practice Address - Country:US
Practice Address - Phone:718-473-2005
Practice Address - Fax:718-523-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243375207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY243375OtherLICENSE