Healthcare Provider Details

I. General information

NPI: 1255329306
Provider Name (Legal Business Name): RESHMA RAJU PANJWANI M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 WASHINGTON ST
HEMPSTEAD NY
11550-4028
US

IV. Provider business mailing address

75 WASHINGTON ST
HEMPSTEAD NY
11550-4028
US

V. Phone/Fax

Practice location:
  • Phone: 516-255-1618
  • Fax:
Mailing address:
  • Phone: 516-255-1618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number149603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: