Healthcare Provider Details

I. General information

NPI: 1548827876
Provider Name (Legal Business Name): PANI FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 06/29/2020
Certification Date: 06/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240D S HIGHLAND AVE
OSSINING NY
10562-6102
US

IV. Provider business mailing address

PO BOX 2500
BRIARCLIFF MANOR NY
10510-0352
US

V. Phone/Fax

Practice location:
  • Phone: 914-502-0881
  • Fax: 914-502-0882
Mailing address:
  • Phone: 914-502-0881
  • Fax: 914-502-0882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. SARAIL GRAVES
Title or Position: EXECUTIVE OFFICE MANAGER
Credential:
Phone: 732-523-5102