Healthcare Provider Details

I. General information

NPI: 1245255611
Provider Name (Legal Business Name): JOSE FRANCISCO PEREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 BROADWAY RM 1C
NEW YORK NY
10033-3768
US

IV. Provider business mailing address

4250 BROADWAY STE 1C
NEW YORK NY
10033-3748
US

V. Phone/Fax

Practice location:
  • Phone: 212-740-3900
  • Fax: 212-740-8232
Mailing address:
  • Phone: 212-740-3900
  • Fax: 212-740-8232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number196310
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: