Healthcare Provider Details

I. General information

NPI: 1003233487
Provider Name (Legal Business Name): MICHELLE MARIA PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HARMON DR
PARAMUS NJ
07652-3218
US

IV. Provider business mailing address

27 HARMON DR
PARAMUS NJ
07652-3218
US

V. Phone/Fax

Practice location:
  • Phone: 201-681-5416
  • Fax:
Mailing address:
  • Phone: 201-681-5416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number280479
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberPENDING
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: