Basic Information
| Provider Information | |||||||||
| NPI: | 1154353159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PANJVANI | ||||||||
| FirstName: | FIROZALI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1879 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100352709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124234400 | ||||||||
| FaxNumber: | 2124234095 | ||||||||
| Practice Location | |||||||||
| Address1: | 1879 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100352709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2124234400 | ||||||||
| FaxNumber: | 2124234095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 192314 | NY | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 02490146 | 05 | NY | MEDICAID |