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NPI Code Detail

MEDICARE: DEBRA PENNA

MEDICARE: DEBRA PENNA
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
1174400000XSpecialist015075-1NY

General Provider Information

NPI Number : 1831321504
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA PENNA
Provider Business Mailing Address
First Line : 1312 MIDDLE COUNTRY RD
Second Line :
City : SELDEN
State : NY
Zip : 11784-2514
Country : US
Telephone Number : 631-732-0700
Fax Number : 631-732-9046
Provider Business Practice Location Address
First Line : 1312 MIDDLE COUNTRY RD
Second Line :
City : SELDEN
State : NY
Zip : 11784-2514
Country : US
Telephone Number : 631-732-0700
Fax Number : 631-732-9046
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2009
Last Update Date : 08/14/2009

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Directions to “ DEBRA PENNA ” Practice Location

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