Healthcare Provider Details

I. General information

NPI: 1144418013
Provider Name (Legal Business Name): THOMAS R PENNY DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 10/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 5TH AVE
NEW YORK NY
10011-8831
US

IV. Provider business mailing address

259 CALIFORNIA QUARRY RD
WOODSTOCK NY
12498-1045
US

V. Phone/Fax

Practice location:
  • Phone: 212-505-0244
  • Fax: 718-904-0073
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN003426
License Number StateNY

VIII. Authorized Official

Name: DR. THOMAS ROBERT PENNY
Title or Position: PRESIDENT
Credential: DPM PC
Phone: 212-505-0244