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General NPI Number Information
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NPI Number | 1184601072
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Entity Type | Individual
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Provider Name | THOMAS PANETTA MD
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Gender | Male
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Dates
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Enumeration Date | 12/30/2005
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 600 NORTHERN BLVD SUITE 115
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City | GREAT NECK
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State | NY
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Zip | 11021-5206
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Country | US
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Telephone | 516-482-8220
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Fax | 516-482-8221
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Provider Business Mailing Address
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Address Line | 600 NORTHERN BLVD SUITE 115
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City | GREAT NECK
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State | NY
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Zip | 11021-5206
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Country | US
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Telephone | 516-482-8220
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Fax | 516-482-8221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 137978
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License Number State | NY
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