Provider Demographics
NPI:1427151794
Name:PENA, CLOTILDE (MD)
Entity type:Individual
Prefix:
First Name:CLOTILDE
Middle Name:
Last Name:PENA
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 1:128 FT WASHINGTN AVE
Mailing Address - Street 2:SUITE 1J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-4721
Mailing Address - Country:US
Mailing Address - Phone:212-923-5050
Mailing Address - Fax:212-923-5055
Practice Address - Street 1:128 FT WASHINGTN AVE
Practice Address - Street 2:SUITE 1J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-4721
Practice Address - Country:US
Practice Address - Phone:212-923-5050
Practice Address - Fax:212-923-5055
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243960208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics