Provider Demographics
NPI:1417291303
Name:PENYY, MARIELLE NICOLE (DVM)
Entity Type:Individual
Prefix:DR
First Name:MARIELLE
Middle Name:NICOLE
Last Name:PENYY
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 DENTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-3424
Mailing Address - Country:US
Mailing Address - Phone:516-742-3377
Mailing Address - Fax:
Practice Address - Street 1:290 DENTON AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-3424
Practice Address - Country:US
Practice Address - Phone:516-742-3377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012104174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian