Provider Demographics
NPI:1588844617
Name:FIRST AVENUE MEDICAL P C
Entity Type:Organization
Organization Name:FIRST AVENUE MEDICAL P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANCHEZ PENA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-533-0972
Mailing Address - Street 1:550 NEWARK AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-1326
Mailing Address - Country:US
Mailing Address - Phone:201-533-0972
Mailing Address - Fax:201-533-8157
Practice Address - Street 1:486 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-4437
Practice Address - Country:US
Practice Address - Phone:646-393-5146
Practice Address - Fax:646-393-5150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C56624Medicare UPIN
NYA100001264Medicare PIN
NYA400010790Medicare PIN