Healthcare Provider Details

I. General information

NPI: 1982917845
Provider Name (Legal Business Name): ALBERTO E PANIZ-MONDOLFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALBERTO E PANIZ MONDOLFI MD., PHD

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 MADISON AVE RM L9-52B
NEW YORK NY
10029-6514
US

IV. Provider business mailing address

10344 68TH AVE APT A
FOREST HILLS NY
11375-3214
US

V. Phone/Fax

Practice location:
  • Phone: 917-355-7530
  • Fax:
Mailing address:
  • Phone: 917-803-1141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZM0300X
TaxonomyMedical Microbiology Physician
License Number301603
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: