Provider Demographics
NPI:1033174511
Name:PENNANT, AINSLEY GEORGE (MD)
Entity Type:Individual
Prefix:MR
First Name:AINSLEY
Middle Name:GEORGE
Last Name:PENNANT
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 1:125 WORTH ST
Mailing Address - Street 2:RM 901 BOX 74 NYCDOHMH DIVISION OF DISEASE CONTROL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4006
Mailing Address - Country:US
Mailing Address - Phone:212-442-8468
Mailing Address - Fax:212-442-8452
Practice Address - Street 1:485 THROOP AVENUE
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221
Practice Address - Country:US
Practice Address - Phone:718-643-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145809207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
49A281Medicare UPIN
NY49A281Medicare ID - Type UnspecifiedEMPIRE
NY0105ALMedicare ID - Type UnspecifiedGHI
B15294Medicare UPIN
NY0105AMMedicare ID - Type UnspecifiedGHI