MEDICARE: DR. MARIA ELENA PENA 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	254727	NY

General Provider Information

NPI Number	:	1487815361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIA ELENA PENA M.D.

Provider Business Mailing Address
First Line	:	9901 QUEENS BLVD
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4512
Country	:	US
Telephone Number	:	718-520-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9901 QUEENS BLVD
Second Line	:
City	:	REGO PARK
State	:	NY
Zip	:	11374-4512
Country	:	US
Telephone Number	:	718-520-6100
Fax Number	:

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

Provider Enumeration Date	:	06/23/2008
Last Update Date	:	06/22/2022

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