Individual
MANUEL PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
22122 110TH AVE, QUEENS VILLAGE, NY 11429-2527
(929) 363-3443
Mailing address
22122 110TH AVE, QUEENS VILLAGE, NY 11429-2527
(929) 363-3443
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
548912586
NY
Other
Enumeration date
08/13/2022
Last updated
08/13/2022
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