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General NPI Number Information
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NPI Number | 1457548745
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Entity Type | Organization
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Legal Business Name | PANCARE MEDICAL PC
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Dates
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Enumeration Date | 10/01/2007
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 15915 HILLSIDE AVE
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City | JAMAICA
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State | NY
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Zip | 11432-3935
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Country | US
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Telephone | 718-473-2005
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Fax | 718-523-2311
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Provider Business Mailing Address
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Address Line | 15915 HILLSIDE AVE
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City | JAMAICA
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State | NY
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Zip | 11432-3935
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Country | US
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Telephone | 718-473-2005
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Fax | 718-523-2311
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SILAS E NWAISHIENYI
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Credential | M.D
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Telephone | 516-610-8704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 243375
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License Number State | NY
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