Healthcare Provider Details

I. General information

NPI: 1578841557
Provider Name (Legal Business Name): ELAINE MARIA PEREIRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3959 BROADWAY # NORTH718
NEW YORK NY
10032-1559
US

IV. Provider business mailing address

3959 BROADWAY # NORTH718
NEW YORK NY
10032-1559
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-6731
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number257442
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number2013140
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: