Healthcare Provider Details

I. General information

NPI: 1053178822
Provider Name (Legal Business Name): EXTERIOR MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 W 238TH ST
BRONX NY
10463-1464
US

IV. Provider business mailing address

3226 OXFORD AVE
BRONX NY
10463-3589
US

V. Phone/Fax

Practice location:
  • Phone: 917-692-3143
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LUISA PEREZ
Title or Position: OWNER/MEDICAL DIRECTOR
Credential: MD
Phone: 917-692-3143