Healthcare Provider Details

I. General information

NPI: 1912401340
Provider Name (Legal Business Name): PATRICIA PERALTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 EASTCHESTER RD STE L2
BRONX NY
10461-2375
US

IV. Provider business mailing address

1695 EASTCHESTER RD STE L2
BRONX NY
10461-2375
US

V. Phone/Fax

Practice location:
  • Phone: 718-405-8200
  • Fax: 718-405-8016
Mailing address:
  • Phone: 718-405-8200
  • Fax: 718-405-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number317005-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: