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General NPI Number Information
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NPI Number | 1760640619
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Entity Type | Organization
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Legal Business Name | THOMAS PANETTA MD VASCULAR SURGERY PLLC
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Dates
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Enumeration Date | 05/28/2008
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Last Update Date | 12/09/2011
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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
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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
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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 | BILLING MANAGER
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Name | JENNIFER BYRNES
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Credential |
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Telephone | 516-482-8220
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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 | 1379781
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License Number State | NY
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