Healthcare Provider Details

I. General information

NPI: 1316911282
Provider Name (Legal Business Name): JOSE R SANCHEZ-PENA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 BROADWAY
PATERSON NJ
07514-2517
US

IV. Provider business mailing address

95 CRESCENT DR
RINGWOOD NJ
07456-1108
US

V. Phone/Fax

Practice location:
  • Phone: 973-653-5686
  • Fax: 201-221-8255
Mailing address:
  • Phone: 973-278-8818
  • Fax: 201-221-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number42837
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number42837
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number42837
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42837
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: