Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 196580 | NY |
NPI | 1003814757 |
---|---|
Provider Name | Dr. Rodrigo Penalosa |
First Address | Mount Kisco, NY 10549-3446 |
Second Address | Hopewell Junction, NY 12533-5367 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 18/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01504750 | (05) | NY |
F89823 | (02) | NY |