Carlos Lenin Pena Diaz, SA-C

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

18-190 Issued in NY

Practice address

69 3Rd Ave
Paterson, NJ 07524-1530

Phone

(201) 450-7799

NPI assigned

Apr 9, 2018

Last updated

Apr 9, 2018By 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

State licenses

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

{
    "created_epoch": "1523232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523232000000",
    "number": "1497252274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "69 3RD AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075241530",
            "telephone_number": "201-450-7799"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 3RD AVE",
            "city": "PATERSON",
            "state": "NJ",
            "postal_code": "075241530",
            "telephone_number": "201-450-7799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENA DIAZ",
        "first_name": "CARLOS",
        "middle_name": "LENIN",
        "credential": "SA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-09",
        "last_updated": "2018-04-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "NY",
            "license": "18-190",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• PB Pharmacy (Cortese Pharmacy)
• Donna A Pearce, M.D.
• Pediatric Associates of Paterson
• Michael Alexander Pelidis, MD
• Kim Pellegrino, RPH
• Joseph Albert Pena, M.D.
• Kristen Pena, D.O.
• Vijay Pendse, MD
• Pennreach
• Julisa Peralta, RDN

• Surgical Assistant in Paterson, NJ
• Providers in Paterson, NJ by specialty
• Surgical Assistant in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2018; 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.