Provider Demographics
NPI:1417020439
Name:PANG, TEODORO Y (MD)
Entity type:Individual
Prefix:DR
First Name:TEODORO
Middle Name:Y
Last Name:PANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TEODORO
Other - Middle Name:Y
Other - Last Name:PANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:176 WOODBURY ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-3508
Mailing Address - Country:US
Mailing Address - Phone:516-931-1978
Mailing Address - Fax:516-932-1475
Practice Address - Street 1:176 WOODBURY RD
Practice Address - Street 2:
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-3018
Practice Address - Country:US
Practice Address - Phone:516-931-1978
Practice Address - Fax:516-932-1475
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY126797208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE42026Medicare UPIN
NY88A721Medicare ID - Type Unspecified