Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | N003785-1 | NY |
NPI | 1134265978 |
---|---|
Provider Name | Dr. William N Panek |
First Address | Alden, NY 14004-1233 |
Second Address | Alden, NY 14004-1233 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000500510001 | BLUE CROSS AND SHIELD (01) | NY |
0061529 | GHI (01) | NY |
T88260 | (02) | NY |