Basic Information
| Provider Information | |||||||||
| NPI: | 1114036175 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUYUMJIAN | ||||||||
| FirstName: | PENIK | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 811 RIVERDELL RD | ||||||||
| Address2: | |||||||||
| City: | ORADELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076492426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2012611562 | ||||||||
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| Practice Location | |||||||||
| Address1: | 800 POLY PL | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112097104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188366600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 183929-1 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.