MEDICARE: BENJAMIN C. H. PENG M.D.

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
1	208800000X	Urology Physician	166349-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356303739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN C. H. PENG M.D.

Provider Business Mailing Address
First Line	:	95 OLD LAKE ST
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-1508
Country	:	US
Telephone Number	:	914-997-2720
Fax Number	:	212-226-0134

Provider Business Practice Location Address
First Line	:	168 CANAL ST
Second Line	:	SUITE 510
City	:	NEW YORK
State	:	NY
Zip	:	10013-4503
Country	:	US
Telephone Number	:	212-226-2200
Fax Number	:	212-226-0134

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	11/06/2008

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