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General NPI Number Information
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NPI Number | 1760646848
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Entity Type | Organization
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Legal Business Name | PENNY PEDIATRICS, INC., P.A.
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Dates
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Enumeration Date | 07/17/2008
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Last Update Date | 07/17/2008
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Provider Practice Location Address
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Address Line | 14430 US HIGHWAY 1 SUITE 101
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City | SEBASTIAN
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State | FL
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Zip | 32958-3289
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Country | US
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Telephone | 772-581-0300
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Fax | 772-581-0010
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Provider Business Mailing Address
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Address Line | 14430 US HIGHWAY 1 SUITE 101
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City | SEBASTIAN
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State | FL
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Zip | 32958-3289
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Country | US
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Telephone | 772-581-0300
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Fax | 772-581-0010
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Authorized Official
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Title or Position | PRES., SEC., TREAS., DIRECTOR
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Name | DR. MARZA PENNY
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Credential | M.D.
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Telephone | 772-581-0300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME0074526
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License Number State | FL
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