Provider Demographics
NPI:1376695361
Name:PENNY, THOMAS R (DPM)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:PENNY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2045 LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2008
Mailing Address - Country:US
Mailing Address - Phone:718-863-4530
Mailing Address - Fax:718-904-0073
Practice Address - Street 1:2045 LAFAYETTE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-2008
Practice Address - Country:US
Practice Address - Phone:718-863-4530
Practice Address - Fax:718-904-0073
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003426213EP1101X
NJMD01710213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine