Provider Demographics
NPI:1528217247
Name:PENA, ROBERTO C (MSED)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:C
Last Name:PENA
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DON LN
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-2304
Mailing Address - Country:US
Mailing Address - Phone:914-592-1685
Mailing Address - Fax:
Practice Address - Street 1:2 DON LN
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-2304
Practice Address - Country:US
Practice Address - Phone:914-592-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services