Provider Demographics
NPI:1043273956
Name:DE PENA-NOWAK, MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:
Last Name:DE PENA-NOWAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:DOLORES
Other - Last Name:DE PENA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:404 MIDLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-3943
Mailing Address - Country:US
Mailing Address - Phone:914-921-1098
Mailing Address - Fax:
Practice Address - Street 1:21 BLOOMINGDALE RD
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1504
Practice Address - Country:US
Practice Address - Phone:914-997-5904
Practice Address - Fax:914-682-9100
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2261362084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
666T41Medicare PIN