1487624144 NPI number — CARRIE FRANCES PANOFF DO

Table of content: CARRIE FRANCES PANOFF DO (NPI 1487624144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487624144 NPI number — CARRIE FRANCES PANOFF DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANOFF
Provider First Name:
CARRIE
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANOFF
Provider Other First Name:
CARRIE
Provider Other Middle Name:
F
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1487624144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
974 RT 45
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
POMONA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-354-1113
Provider Business Mailing Address Fax Number:
845-354-1813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
974 RT 45
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
POMONA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-354-1113
Provider Business Practice Location Address Fax Number:
845-354-1813
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  231098 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02686051 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00922923 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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