Provider Demographics
NPI:1962912196
Name:PENSA, DANIELLE MEGHAN
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:MEGHAN
Last Name:PENSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 S LEXINGTON AVE UNIT 7
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10606-2572
Mailing Address - Country:US
Mailing Address - Phone:845-548-5638
Mailing Address - Fax:
Practice Address - Street 1:NEW YORK PRESBYTERIAN, LAWRENCE HOSPITAL
Practice Address - Street 2:55 PALMER AVE
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708
Practice Address - Country:US
Practice Address - Phone:914-787-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021408363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical