Healthcare Provider Details

I. General information

NPI: 1538154174
Provider Name (Legal Business Name): PENINA BURNSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1318 52ND ST
BROOKLYN NY
11219-3802
US

IV. Provider business mailing address

PO BOX 190233
BROOKLYN NY
11219-0233
US

V. Phone/Fax

Practice location:
  • Phone: 718-437-4500
  • Fax: 718-871-2052
Mailing address:
  • Phone: 718-437-4500
  • Fax: 718-871-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number184158
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: