Provider Demographics
NPI:1164733432
Name:FENIG, PENINA PEARL (MS,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PENINA
Middle Name:PEARL
Last Name:FENIG
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 COLUMBUS AVE
Mailing Address - Street 2:APARTMENT 3A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5150
Mailing Address - Country:US
Mailing Address - Phone:646-403-7467
Mailing Address - Fax:
Practice Address - Street 1:440 AVENUE P
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1935
Practice Address - Country:US
Practice Address - Phone:718-376-5510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist