Healthcare Provider Details

I. General information

NPI: 1730002254
Provider Name (Legal Business Name): VICTOR PEREZ PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E 77TH ST
NEW YORK NY
10075-1850
US

IV. Provider business mailing address

876 WASHINGTON AVE
WESTBURY NY
11590-6014
US

V. Phone/Fax

Practice location:
  • Phone: 212-434-2000
  • Fax:
Mailing address:
  • Phone: 516-503-1170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: