Provider Demographics
NPI:1801888995
Name:PANEBIANCO, PAUL S (DO)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:S
Last Name:PANEBIANCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:129 JOHNSON RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-1777
Mailing Address - Country:US
Mailing Address - Phone:856-374-4440
Mailing Address - Fax:856-374-4445
Practice Address - Street 1:129 JOHNSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-1777
Practice Address - Country:US
Practice Address - Phone:856-374-4440
Practice Address - Fax:856-374-4445
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMB03115000207RN0300X
PAOS003416L207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1288300Medicaid
NJ1288300Medicaid
NJP00064543Medicare PIN
C57932Medicare UPIN