Christian David Pena

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

012087 Issued in NY

Practice address

63 Oakcrest Ave
Middle Island, NY 11953-1415

Phone

(631) 594-3800

NPI assigned

Dec 9, 2020

Last updated

May 18, 2025By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747526400000",
    "number": "1417553967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "84 GLEN HOLLOW DRIVE",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117763511",
            "telephone_number": "914-218-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 OAKCREST AVE",
            "city": "MIDDLE ISLAND",
            "state": "NY",
            "postal_code": "119531415",
            "telephone_number": "631-594-3800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6 Frowein Rd",
            "address_purpose": "LOCATION",
            "city": "Center Moriches",
            "state": "NY",
            "postal_code": "119341604",
            "country_code": "US",
            "telephone_number": "631-878-4400",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "78 Old Country Rd",
            "address_purpose": "LOCATION",
            "city": "Westhampton",
            "state": "NY",
            "postal_code": "119771219",
            "country_code": "US",
            "telephone_number": "631-288-0101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENA",
        "first_name": "CHRISTIAN",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-12-09",
        "last_updated": "2025-05-18",
        "certification_date": "2025-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NY",
            "license": "012087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Patti, M.A.
• Emilia Pawelski
• Ronald John Peckholdt, LCSW
• Johanna Nicole Pedone
• Michelle Ann Pelosi, MA
• Meghan C. Penkower, M.A.
• Alyssa Lynne Perillo, B.A.
• Kimberly Perone, MS, OTR/L
• Rose Christine Peterson, NPP
• Lynn Picucci, SLP

• Physical Therapy Assistant in Middle Island, NY
• Providers in Middle Island, NY by specialty
• Physical Therapy Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.