Healthcare Provider Details

I. General information

NPI: 1093448680
Provider Name (Legal Business Name): NINNET MARIELA PEREYRA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 BROADWAY FL 4F
NEW YORK NY
10013-6023
US

IV. Provider business mailing address

6415 MYRTLE AVE APT 1L
GLENDALE NY
11385-6208
US

V. Phone/Fax

Practice location:
  • Phone: 212-966-9537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: