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General NPI Number Information
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NPI Number | 1417553967
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Entity Type | Individual
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Provider Name | CHRISTIAN DAVID PENA
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Gender | Male
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Dates
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Enumeration Date | 12/09/2020
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Last Update Date | 05/18/2025
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Provider Practice Location Address
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Address Line | 63 OAKCREST AVE
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City | MIDDLE ISLAND
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State | NY
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Zip | 11953-1415
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Country | US
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Telephone | 631-594-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 84 GLEN HOLLOW DRIVE
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3511
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Country | US
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Telephone | 914-218-0040
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Fax |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 012087
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License Number State | NY
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