Basic Information
| Provider Information | |||||||||
| NPI: | 1568413698 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PENZONE | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CONTINENTAL DR | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027094497 | ||||||||
| FaxNumber: | 3027330854 | ||||||||
| Practice Location | |||||||||
| Address1: | 111 CONTINENTAL DR | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197134306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3027094497 | ||||||||
| FaxNumber: | 3027330854 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 02/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 25MA07461600 | NJ | Y | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 25MA07461600 | 01 | NJ | MEDICAL LICENSE | OTHER |