Provider Demographics
NPI:1548827876
Name:PANI FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:PANI FAMILY MEDICINE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-523-5102
Mailing Address - Street 1:PO BOX 2500
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-0352
Mailing Address - Country:US
Mailing Address - Phone:914-502-0881
Mailing Address - Fax:914-502-0882
Practice Address - Street 1:240D S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-6102
Practice Address - Country:US
Practice Address - Phone:914-502-0881
Practice Address - Fax:914-502-0882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY228991OtherNY STATE BOARD OF MEDICINE