Provider Demographics
NPI:1518952654
Name:PENG, JINPENG (MD)
Entity Type:Individual
Prefix:
First Name:JINPENG
Middle Name:
Last Name:PENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8847 17TH AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-5812
Mailing Address - Country:US
Mailing Address - Phone:201-952-3299
Mailing Address - Fax:347-295-1259
Practice Address - Street 1:863 50TH ST
Practice Address - Street 2:M6
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2417
Practice Address - Country:US
Practice Address - Phone:347-240-8482
Practice Address - Fax:347-295-1259
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY233523208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02610240Medicaid
NYI22370Medicare UPIN
NY02610240Medicaid