Provider Demographics
NPI:1316911282
Name:SANCHEZ-PENA, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:SANCHEZ-PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-1108
Mailing Address - Country:US
Mailing Address - Phone:973-278-8818
Mailing Address - Fax:201-221-8255
Practice Address - Street 1:583 BROADWAY
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07514-2517
Practice Address - Country:US
Practice Address - Phone:973-653-5686
Practice Address - Fax:201-221-8255
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ42837207RS0012X, 207RG0300X, 207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00836824Medicaid
NJ6846505Medicaid
NJ0469807Medicaid
NY00836824Medicaid
NJ0469807Medicaid
NJ043361Medicare PIN
C56624Medicare UPIN
NY20D363Medicare PIN
NJ090482Medicare PIN