Healthcare Provider Details

I. General information

NPI: 1174849947
Provider Name (Legal Business Name): PENG CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 LEHIGH AVE
UNION NJ
07083-7631
US

IV. Provider business mailing address

PO BOX 492 PO BOX 492
MORRIS PLAINS NJ
07950-0492
US

V. Phone/Fax

Practice location:
  • Phone: 646-220-0050
  • Fax:
Mailing address:
  • Phone: 646-220-0050
  • Fax: 646-395-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number222042-1
License Number StateNY

VIII. Authorized Official

Name: DR. MINZHONG PENG
Title or Position: PRESIDENT
Credential: MD
Phone: 646-220-0050