Provider Demographics
NPI:1700965415
Name:PENA, OMAR A (MD)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:A
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:781 EAST 142 STREET
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10454-1723
Mailing Address - Country:US
Mailing Address - Phone:718-993-1400
Mailing Address - Fax:718-993-0647
Practice Address - Street 1:1241 LAFAYETTE AVENUE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10474-5336
Practice Address - Country:US
Practice Address - Phone:718-387-6500
Practice Address - Fax:718-842-3846
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221331-12084P0800X
NY2213312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry