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NPI Code Detail

MEDICARE: FLERIDA PENA SC

MEDICARE:   FLERIDA  PENA  SC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency

General Provider Information

NPI Number : 1265795843
Entity Type Code : Individual
Provider Name (Legal Business Name) : FLERIDA PENA SC
Provider Business Mailing Address
First Line : 674 E 149TH ST
Second Line : 6G
City : BRONX
State : NY
Zip : 10455-4313
Country : US
Telephone Number : 718-409-4227
Fax Number : 718-409-5708
Provider Business Practice Location Address
First Line : 2433 E TREMONT AVE
Second Line :
City : BRONX
State : NY
Zip : 10461-2801
Country : US
Telephone Number : 718-409-4227
Fax Number : 718-409-5708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2012
Last Update Date : 06/19/2012

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Directions to “ FLERIDA PENA SC” Practice Location

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