Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N004421 | NY |
Y | 222Z00000X | Podiatrist | N004421 | NY |
NPI | 1013918846 |
---|---|
Provider Name | Dr. Richard Panvini |
First Address | Dix Hills, NY 11746-5509 |
Second Address | Dix Hills, NY 11746-5509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 04/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01182329 | (05) | NY |
T83578 | (02) | NY |