Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0204X | Pediatric Emergency Doctor | 200803 | NY |
NPI | 1174571152 |
---|---|
Provider Name | Dr. Michelle Dolores Penque |
First Address | Buffalo, NY 14203-1009 |
Second Address | Buffalo, NY 14203-1009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 20/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00010310201 | UNIVERA (01) | |
000524862001 | BC/BS (01) | |
0018522750001 | (05) | PA |
01776672 | (05) | NY |
040426001461 | FIDELIS (01) | |
3990839 | IHA (01) | |
G57336 | (02) |