MEDICARE: DR. EVANGELINE PEREZ DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	222603	NY

General Provider Information

NPI Number	:	1891761334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVANGELINE PEREZ DO

Provider Business Mailing Address
First Line	:	515 84TH ST
Second Line	:	1ST FL
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4701
Country	:	US
Telephone Number	:	347-497-4984
Fax Number	:	347-497-4980

Provider Business Practice Location Address
First Line	:	515 84TH ST
Second Line	:	1ST FL
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4701
Country	:	US
Telephone Number	:	347-497-4984
Fax Number	:	347-497-4980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	06/06/2011

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Directions to “ DR. EVANGELINE PEREZ DO” Practice Location

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