Individual
MR. JUAN PENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1831 GRAND CONCOURSE, BRONX, NY 10453-6323
(718) 365-6691
(718) 364-7777
Mailing address
1831 GRAND CONCOURSE, BRONX, NY 10453-6323
(718) 365-6691
(718) 364-7777
Taxonomy
Speciality
Code
Description
License number
State
111NN0400X
Neurology Chiropractor
111NN0400X
NY
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
213E00000X
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUPER1626
—
NY
Enumeration date
09/18/2014
Last updated
09/18/2014
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