Provider Demographics
NPI:1497257976
Name:PENA, IANCA
Entity Type:Individual
Prefix:MS
First Name:IANCA
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W 38TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9537
Mailing Address - Country:US
Mailing Address - Phone:212-695-4564
Mailing Address - Fax:212-695-4561
Practice Address - Street 1:307 W 38TH ST FL 6
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9537
Practice Address - Country:US
Practice Address - Phone:212-695-4564
Practice Address - Fax:212-695-4561
Is Sole Proprietor?:No
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator