Provider Demographics
NPI:1760646848
Name:PENNY PEDIATRICS, INC., P.A.
Entity Type:Organization
Organization Name:PENNY PEDIATRICS, INC., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES., SEC., TREAS., DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARZA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-581-0300
Mailing Address - Street 1:14430 US HIGHWAY 1
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-3289
Mailing Address - Country:US
Mailing Address - Phone:772-581-0300
Mailing Address - Fax:772-581-0010
Practice Address - Street 1:14430 US HIGHWAY 1
Practice Address - Street 2:SUITE 101
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3289
Practice Address - Country:US
Practice Address - Phone:772-581-0300
Practice Address - Fax:772-581-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074526208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG64500Medicare UPIN