Healthcare Provider Details

I. General information

NPI: 1831600097
Provider Name (Legal Business Name): ELENE LUCIA PEREYRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 WEST 135TH ST
NEW YORK NY
10031-3499
US

IV. Provider business mailing address

14 ALTAMONT PL APT 1
YONKERS NY
10704-3173
US

V. Phone/Fax

Practice location:
  • Phone: 212-694-9200
  • Fax: 212-368-5608
Mailing address:
  • Phone: 347-407-0921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number328460
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number782931
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number408084
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: