Provider Demographics
NPI:1578682241
Name:PENN, DAVID J (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:PENN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3 UNIVERSITY PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6208
Mailing Address - Country:US
Mailing Address - Phone:201-833-3000
Mailing Address - Fax:
Practice Address - Street 1:730 PALISADE AVE
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3144
Practice Address - Country:US
Practice Address - Phone:201-353-9000
Practice Address - Fax:201-530-0002
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MP00041700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114346Medicare PIN