Provider Demographics
NPI:1497469860
Name:PANKO, JEFFREY M (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:M
Last Name:PANKO
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5911 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-2602
Mailing Address - Country:US
Mailing Address - Phone:646-549-5694
Mailing Address - Fax:979-270-9082
Practice Address - Street 1:5911 23RD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2602
Practice Address - Country:US
Practice Address - Phone:646-479-4522
Practice Address - Fax:979-270-9082
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2024-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health