Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213EP1101X | Primary Podiatric Medicine | MD01710 | NJ |
Y | 213EP1101X | Primary Podiatric Medicine | N003426 | NY |
NPI | 1376695361 |
---|---|
Provider Name | Thomas R Penny |
First Address | Bronx, NY 10473-2008 |
Second Address | Bronx, NY 10473-2008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 08/07/2007 |