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General NPI Number Information
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NPI Number | 1144418013
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Entity Type | Organization
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Legal Business Name | THOMAS R PENNY DPM PC
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 10/04/2007
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Provider Practice Location Address
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Address Line | 20 5TH AVE
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City | NEW YORK
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State | NY
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Zip | 10011-8831
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Country | US
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Telephone | 212-505-0244
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Fax | 718-904-0073
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Provider Business Mailing Address
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Address Line | 259 CALIFORNIA QUARRY RD
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City | WOODSTOCK
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State | NY
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Zip | 12498-1045
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THOMAS ROBERT PENNY
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Credential | DPM PC
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Telephone | 212-505-0244
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N003426
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License Number State | NY
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