Healthcare Provider Details

I. General information

NPI: 1427151794
Provider Name (Legal Business Name): CLOTILDE PENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 03/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 FT WASHINGTN AVE SUITE 1J
NEW YORK NY
10032-4721
US

IV. Provider business mailing address

128 FT WASHINGTN AVE SUITE 1J
NEW YORK NY
10032-4721
US

V. Phone/Fax

Practice location:
  • Phone: 212-923-5050
  • Fax: 212-923-5055
Mailing address:
  • Phone: 212-923-5050
  • Fax: 212-923-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number243960
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: