Pavo Cristatus Medical PC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PAVO CRISTATUS MEDICAL PC

Practice address

1010 Northern Blvd Ste 208
Great Neck, NY 11021-5320

Phone

(718) 464-0122

NPI assigned

Apr 5, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ramkumar Panhani, MD

Title

President

Phone

(718) 464-0122

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1972065068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BLVD STE 208",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215320",
            "telephone_number": "718-464-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 NORTHERN BLVD STE 208",
            "city": "GREAT NECK",
            "state": "NY",
            "postal_code": "110215320",
            "telephone_number": "718-464-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAVO CRISTATUS MEDICAL PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-05",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "PANHANI",
        "authorized_official_first_name": "RAMKUMAR",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-464-0122",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01583586",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Great Neck, NY
• Providers in Great Neck, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.