Basic Information
| Provider Information | |||||||||
| NPI: | 1831333541 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENG | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 671 HOES LN W # C205 | ||||||||
| Address2: | UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL | ||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088548021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322354063 | ||||||||
| FaxNumber: | 7322354649 | ||||||||
| Practice Location | |||||||||
| Address1: | 671 HOES LN W # C205 | ||||||||
| Address2: | UMDNJ-ROBERT WOOD JOHNSON MEDICAL SCHOOL | ||||||||
| City: | PISCATAWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088548021 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322354063 | ||||||||
| FaxNumber: | 7322354649 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2009 | ||||||||
| LastUpdateDate: | 04/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 25MB08537300 | NJ | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.