Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 182327 | NY |
NPI | 1952482762 |
---|---|
Provider Name | Gina Penzi Luxemberg |
First Address | Huntington, NY 11743-4240 |
Second Address | Huntington, NY 11743-4240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F27062 | (02) | NY |