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General NPI Number Information
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NPI Number | 1740521483
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Entity Type | Individual
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Provider Name | MS. RENEE EVA PENA
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Gender | Female
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 03/05/2013
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Provider Practice Location Address
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Address Line | 22C W 34TH ST
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City | BAYONNE
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State | NJ
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Zip | 07002-8688
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Country | US
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Telephone | 917-755-3572
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Fax |
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Provider Business Mailing Address
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Address Line | 22C W 34TH ST
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City | BAYONNE
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State | NJ
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Zip | 07002-8688
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Country | US
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Telephone | 917-755-3572
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 712779131
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License Number State | NY
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