Healthcare Provider Details

I. General information

NPI: 1336236769
Provider Name (Legal Business Name): DESIREE CONSUELO PEREZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 WOODSIDE AVE SUITE 204
BRIARCLIFF MANOR NY
10510-1461
US

IV. Provider business mailing address

127 WOODSIDE AVE SUITE 204
BRIARCLIFF MANOR NY
10510-1461
US

V. Phone/Fax

Practice location:
  • Phone: 914-762-2276
  • Fax: 914-762-2894
Mailing address:
  • Phone: 914-762-2276
  • Fax: 914-762-2894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number168116
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: