Healthcare Provider Details

I. General information

NPI: 1467435248
Provider Name (Legal Business Name): CYNTHIA ANN BEOJEKIAN-PENA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 ROUTE 23B
LEEDS NY
12451-1641
US

IV. Provider business mailing address

746 ROUTE 23B
LEEDS NY
12451-1641
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-8010
  • Fax: 844-296-0302
Mailing address:
  • Phone: 518-731-8010
  • Fax: 844-296-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX0055880-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4411
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: