Healthcare Provider Details

I. General information

NPI: 1255962940
Provider Name (Legal Business Name): DANIEL PEREDO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E 38TH ST FL 5
NEW YORK NY
10016-2772
US

IV. Provider business mailing address

333 E 38TH ST FL 5
NEW YORK NY
10016-2772
US

V. Phone/Fax

Practice location:
  • Phone: 646-501-7077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number039204
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: