Healthcare Provider Details

I. General information

NPI: 1861661225
Provider Name (Legal Business Name): MARIA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 7TH AVE
BROOKLYN NY
11215-3689
US

IV. Provider business mailing address

263 7TH AVE
BROOKLYN NY
11215-3689
US

V. Phone/Fax

Practice location:
  • Phone: 718-369-8000
  • Fax: 718-369-8059
Mailing address:
  • Phone: 718-369-8000
  • Fax: 718-369-8059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number014989
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: