Healthcare Provider Details

I. General information

NPI: 1043200827
Provider Name (Legal Business Name): MANUEL GARCIA PEREZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 E 138TH ST
BRONX NY
10454-3087
US

IV. Provider business mailing address

183 MAMARONECK RD
SCARSDALE NY
10583-4527
US

V. Phone/Fax

Practice location:
  • Phone: 718-993-5959
  • Fax: 718-993-5959
Mailing address:
  • Phone: 914-723-8779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number113690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: