Healthcare Provider Details

I. General information

NPI: 1518861020
Provider Name (Legal Business Name): DIVINE EMILIO PEREZ-FERREIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FAMILY PRACTICE DR
KINGSTON NY
12401-6449
US

IV. Provider business mailing address

361 WASHINGTON AVE APT 3
KINGSTON NY
12401-3746
US

V. Phone/Fax

Practice location:
  • Phone: 845-338-2562
  • Fax: 845-633-5975
Mailing address:
  • Phone: 929-476-7057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: