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General NPI Number Information
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NPI Number | 1386769289
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Entity Type | Individual
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Provider Name | JOSEPH EDWARD PENA M.D
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Gender | Male
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Dates
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Enumeration Date | 03/20/2007
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Last Update Date | 01/02/2012
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Provider Practice Location Address
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Address Line | 8 CORPORATE CENTER DR SUITE 101
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City | MELVILLE
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State | NY
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Zip | 11747-3193
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Country | US
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Telephone | 631-752-0606
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Fax | 631-752-0623
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Provider Business Mailing Address
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Address Line | 22 WATERVILLE RD INVITRO SCIENCES, INC
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City | AVON
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State | CT
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Zip | 06001-2066
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Country | US
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Telephone | 860-678-3428
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Fax | 860-284-5444
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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 | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 216748-1
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License Number State | NY
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