Provider Demographics
NPI:1457520967
Name:PENINA BURNSTEIN MD PLLC
Entity Type:Organization
Organization Name:PENINA BURNSTEIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-437-4500
Mailing Address - Street 1:PO BOX 190233
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-0233
Mailing Address - Country:US
Mailing Address - Phone:718-437-4500
Mailing Address - Fax:718-504-3817
Practice Address - Street 1:1318 52ND STREET
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219
Practice Address - Country:US
Practice Address - Phone:718-437-4500
Practice Address - Fax:718-871-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184158207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF78586Medicare UPIN