MEDICARE: MR. FRANCINE PANELY PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	01756	NY

General Provider Information

NPI Number	:	1336651629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANCINE PANELY PA

Provider Business Mailing Address
First Line	:	460 NEPTUNE AVE APT 18R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4325
Country	:	US
Telephone Number	:	917-903-3329
Fax Number	:	718-996-4661

Provider Business Practice Location Address
First Line	:	460 NEPTUNE AVE APT 18R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-4325
Country	:	US
Telephone Number	:	917-903-3329
Fax Number	:	718-996-4661

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2017
Last Update Date	:	10/26/2017

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