Individual
DR. MICHELLE GUEVARRA PENA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
14A JAYNE AVENUE, PATCHOGUE, NY 11772
(631) 475-0222
(631) 475-4586
Mailing address
14A JAYNE AVENUE, PATCHOGUE, NY 11772
(631) 475-0222
(631) 475-4586
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
2095111
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082260
GHI HMO
—
05
—
02315391
—
NY
01
—
0498205
GHI PPO
—
01
—
113660574
MAGNACARE
—
01
—
1800045562
RR RETIREMENT MEDICARE
—
01
—
180045562
RR RETIREMENT MEDICARE
—
01
—
2087772
FIRST HEALTH
—
01
—
2095111
HIP
—
01
—
2095115W
WORKERS COMP
NY
01
—
3080739
AETNA US HEALTHCARE HMO
—
01
—
3818002003
CIGNA
—
01
—
3C3882
HEALTNET
—
01
—
430A71
EMPIRE BLUE CROSS BLUE SH
—
01
—
7121410
AETNA US HEALTHCARE PPO
—
01
—
AA72021
MDNY
—
01
—
P2807516
OXFORD
—
Enumeration date
04/13/2006
Last updated
12/30/2020
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