MEDICARE: DR. XELENIA DEPENA 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	207Q00000X	Family Medicine Physician	295052	NY
2	207Q00000X	Family Medicine Physician	25MA11195800	NJ

General Provider Information

NPI Number	:	1750778973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. XELENIA DEPENA M.D.

Provider Business Mailing Address
First Line	:	40 WASHINGTON AVE STE A5
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-3636
Country	:	US
Telephone Number	:	201-387-7705
Fax Number	:	201-387-8605

Provider Business Practice Location Address
First Line	:	40 WASHINGTON AVE STE A5
Second Line	:
City	:	DUMONT
State	:	NJ
Zip	:	07628-3636
Country	:	US
Telephone Number	:	201-387-7705
Fax Number	:	201-387-8605

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

Provider Enumeration Date	:	04/26/2015
Last Update Date	:	01/28/2026

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Directions to “ DR. XELENIA DEPENA M.D.” Practice Location

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