Provider Demographics
NPI:1285691469
Name:PANAYOTOV, PANAYOT (MD)
Entity type:Individual
Prefix:
First Name:PANAYOT
Middle Name:
Last Name:PANAYOTOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RAHWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3505
Mailing Address - Country:US
Mailing Address - Phone:973-926-7582
Mailing Address - Fax:973-705-8301
Practice Address - Street 1:201 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7582
Practice Address - Fax:973-705-8301
Is Sole Proprietor?:No
Enumeration Date:2006-04-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ68509207ZB0001X, 207ZP0102X
NY205935207ZB0001X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY823521Medicaid
NY02056499Medicaid
NY02056499Medicaid
NJH10019Medicare UPIN