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NPI Code Detail

MEDICARE: MR. THOMAS WILLIAM PANZELLA PA-C

MEDICARE: MR. THOMAS WILLIAM PANZELLA PA-C
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
1363AM0700XMedical Physician Assistant001196NY

General Provider Information

NPI Number : 1346212578
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. THOMAS WILLIAM PANZELLA PA-C
Provider Business Mailing Address
First Line : 760 PARKSIDE AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-1508
Country : US
Telephone Number : 718-282-1722
Fax Number :
Provider Business Practice Location Address
First Line : 760 PARKSIDE AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-1508
Country : US
Telephone Number : 718-282-1722
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2006
Last Update Date : 06/10/2008

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