Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 268930 | NY |
NPI | 1306133822 |
---|---|
Provider Name | Dr. Alexis Pankow |
First Address | Brooklyn, NY 11201-3938 |
Second Address | New York, NY 10016-9196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2011 |
Last Update Date | 10/03/2021 |