Provider Demographics
NPI:1396703898
Name:PENSTEIN, ALYSON CHANI (MD)
Entity type:Individual
Prefix:DR
First Name:ALYSON
Middle Name:CHANI
Last Name:PENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E 66TH ST
Mailing Address - Street 2:1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-6547
Mailing Address - Country:US
Mailing Address - Phone:212-517-5171
Mailing Address - Fax:212-517-5181
Practice Address - Street 1:116 E 66TH ST
Practice Address - Street 2:1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6547
Practice Address - Country:US
Practice Address - Phone:212-517-5171
Practice Address - Fax:212-517-5181
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP2175670OtherOXFORD
NYP2175670OtherOXFORD
25050Medicare UPIN