Healthcare Provider Details

I. General information

NPI: 1831014737
Provider Name (Legal Business Name): 5TH AVENUE MEDICAL HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5407 5TH AVE
BROOKLYN NY
11220-6405
US

IV. Provider business mailing address

5407 5TH AVE
BROOKLYN NY
11220-6405
US

V. Phone/Fax

Practice location:
  • Phone: 718-492-4109
  • Fax: 718-492-2082
Mailing address:
  • Phone: 718-492-4109
  • Fax: 718-492-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSE SANCHEZ PENA
Title or Position: PRESIDENT
Credential: MD
Phone: 862-222-0566