Individual
MICHAEL CRAIG PENCHUK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2125 HOLLAND WAY, MERRICK, NY 11566-5421
(516) 771-7090
Mailing address
2125 HOLLAND WAY, MERRICK, NY 11566-5421
(516) 771-7090
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
005080
NY
213E00000X
Podiatrist
25MD00225600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6200811
GHI
—
01
—
P1100931
OXFORD HEALTH PLANS
—
Enumeration date
09/30/2006
Last updated
07/08/2007
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