Provider Demographics
NPI:1487624144
Name:PANOFF, CARRIE FRANCES (DO)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:FRANCES
Last Name:PANOFF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:F
Other - Last Name:PANOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:974 RT 45
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970
Mailing Address - Country:US
Mailing Address - Phone:845-354-1113
Mailing Address - Fax:845-354-1813
Practice Address - Street 1:974 RT 45
Practice Address - Street 2:SUITE 1000
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970
Practice Address - Country:US
Practice Address - Phone:845-354-1113
Practice Address - Fax:845-354-1813
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY231098207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02686051Medicaid
NYP00922923OtherRAILROAD MEDICARE
NYP00922923OtherRAILROAD MEDICARE
NY02686051Medicaid
NY729C81Medicare PIN