Healthcare Provider Details

I. General information

NPI: 1285869677
Provider Name (Legal Business Name): HEALTH DEVELOPMENT & RESTORATIVE MEDICINE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2009
Last Update Date: 07/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1469 BEACH AVE MEDICAL OFFICE
BRONX NY
10460-3630
US

IV. Provider business mailing address

1469 BEACH AVE MEDICAL OFFICE
BRONX NY
10460-3630
US

V. Phone/Fax

Practice location:
  • Phone: 347-810-9001
  • Fax:
Mailing address:
  • Phone: 347-810-9001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number231817
License Number StateNY

VIII. Authorized Official

Name: DR. ANDREA PEREZ
Title or Position: PRESIDENT
Credential: D.O.
Phone: 631-682-5163