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NPI Code Detail

MEDICARE: BRANDON PENA MD

MEDICARE:   BRANDON  PENA  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1497458616
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDON PENA MD
Provider Business Mailing Address
First Line : DEPARTMENT OF SURGERY HSC T-19, 030
Second Line :
City : STONY BROOK
State : NY
Zip : 11794-8191
Country : US
Telephone Number : 631-444-1791
Fax Number : 631-444-7689
Provider Business Practice Location Address
First Line : DEPARTMENT OF SURGERY HSC T-19, 030
Second Line :
City : STONY BROOK
State : NY
Zip : 11794-8191
Country : US
Telephone Number : 631-444-1791
Fax Number : 631-444-7689
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/24/2023
Last Update Date : 03/24/2023

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Directions to “ BRANDON PENA MD” Practice Location

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