Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VE0102X | Reproductive Endocrinologist | 216748-1 | NY |
NPI | 1386769289 |
---|---|
Provider Name | Dr. Joseph Edward Pena |
First Address | Avon, CT 06001-2066 |
Second Address | Melville, NY 11747-3193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 02/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
216748 | NY LICENSE (01) | NY |