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General NPI Number Information
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NPI Number | 1356303739
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Entity Type | Individual
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Provider Name | BENJAMIN C. H. PENG M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2006
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 168 CANAL ST SUITE 510
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City | NEW YORK
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State | NY
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Zip | 10013-4503
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Country | US
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Telephone | 212-226-2200
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Fax | 212-226-0134
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Provider Business Mailing Address
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Address Line | 95 OLD LAKE ST
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City | WEST HARRISON
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State | NY
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Zip | 10604-1508
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Country | US
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Telephone | 914-997-2720
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Fax | 212-226-0134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 166349-1
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License Number State | NY
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