Most Relevant Information
Provider Data
| NPI Number: | 1003211590 |
| Provider Name: | JENNIFER PENA |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: | 23818 |
Most Important Dates
| Enumeration Date: | 10/27/2014 |
| Last Updated: | 10/27/2014 |
Provider Practice Location
37 JOHN ST
AMITYVILLE
NY
117012930
Practice Location Phone/Fax
| Phone: | 6314242900 |
| Fax: | 6316081017 |
Provider Mailing Location
37 JOHN ST
AMITYVILLE
NY
117012930
Provider Mailing Phone/Fax
| Phone: | 6314242900 |
| Fax: | 6316081017 |