Healthcare Provider Details

I. General information

NPI: 1124279013
Provider Name (Legal Business Name): PENG'S MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

863 50TH ST M6
BROOKLYN NY
11220-2417
US

IV. Provider business mailing address

863 50TH ST M6
BROOKLYN NY
11220-2417
US

V. Phone/Fax

Practice location:
  • Phone: 347-240-8482
  • Fax: 347-295-1259
Mailing address:
  • Phone: 347-240-8482
  • Fax: 347-295-1259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number233523
License Number StateNY

VIII. Authorized Official

Name: DR. JINPENG PENG
Title or Position: PRESIDENT
Credential: MD
Phone: 347-240-8482