Healthcare Provider Details

I. General information

NPI: 1912289828
Provider Name (Legal Business Name): PENNY SAXON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2011
Last Update Date: 09/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE GUSTAVE L. LEVY PLACE BOX 1234 DEPARTMENT OF RADIOLOGY THE MOUNT SINAI MEDICAL CENTER
NEW YORK NY
10029-6574
US

IV. Provider business mailing address

10 SEWARD DR
WOODBURY NY
11797-2609
US

V. Phone/Fax

Practice location:
  • Phone: 212-241-7416
  • Fax:
Mailing address:
  • Phone: 516-816-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number60260253
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number60260253
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: