Most Relevant Information
Provider Data
| NPI Number: | 1003396839 |
| Provider Name: | DIANE PANCHAK |
| Entity Type: | Individual |
| Taxonomy Code: | 174400000X |
| Specialty: | Specialist |
| License Number: | 536926360 |
Most Important Dates
| Enumeration Date: | 08/21/2018 |
| Last Updated: | 08/21/2018 |
Provider Practice Location
18 CENTER DR
RIVERHEAD
NY
119011078
Practice Location Phone/Fax
| Phone: | 6317747767 |
| Fax: |
Provider Mailing Location
18 CENTER DR
RIVERHEAD
NY
119011078
Provider Mailing Phone/Fax
| Phone: | 6317747767 |
| Fax: |