Healthcare Provider Details

I. General information

NPI: 1265794366
Provider Name (Legal Business Name): PENELOPE HUGGINS CUEVAS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 TALON DR
SCHENECTADY NY
12309-1840
US

IV. Provider business mailing address

13 TALON DR
SCHENECTADY NY
12309-1840
US

V. Phone/Fax

Practice location:
  • Phone: 212-203-6454
  • Fax:
Mailing address:
  • Phone: 212-203-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083C0008X
TaxonomyClinical Informatics Physician
License Number273449
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: