Provider Demographics
NPI:1124279013
Name:PENG'S MEDICAL, P.C.
Entity type:Organization
Organization Name:PENG'S MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JINPENG
Authorized Official - Middle Name:
Authorized Official - Last Name:PENG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:347-240-8482
Mailing Address - Street 1:863 50TH ST
Mailing Address - Street 2:M6
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2417
Mailing Address - Country:US
Mailing Address - Phone:347-240-8482
Mailing Address - Fax:347-295-1259
Practice Address - Street 1:863 50TH ST
Practice Address - Street 2:M6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2417
Practice Address - Country:US
Practice Address - Phone:347-240-8482
Practice Address - Fax:347-295-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY233523208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02610240Medicaid
NY02610240Medicaid
NY605Y91Medicare PIN