Healthcare Provider Details

I. General information

NPI: 1104225986
Provider Name (Legal Business Name): JOAQUIN JOSE MOYA ANGELER PEREZ MATEOS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E 70TH ST
NEW YORK NY
10021-4823
US

IV. Provider business mailing address

400 E 71ST ST APT 4Q
NEW YORK NY
10021-4809
US

V. Phone/Fax

Practice location:
  • Phone: 917-929-7633
  • Fax:
Mailing address:
  • Phone: 917-929-7633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: