Healthcare Provider Details

I. General information

NPI: 1114036175
Provider Name (Legal Business Name): PENIK KUYUMJIAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLY PL
BROOKLYN NY
11209-7104
US

IV. Provider business mailing address

811 RIVERDELL RD
ORADELL NJ
07649-2426
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-6600
  • Fax:
Mailing address:
  • Phone: 201-261-1562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number183929-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: