Healthcare Provider Details

I. General information

NPI: 1265148167
Provider Name (Legal Business Name): JENNIFER PEROS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1087 ROUTE 58 # 1034
RIVERHEAD NY
11901-2141
US

IV. Provider business mailing address

1087 ROUTE 58 # 1034
RIVERHEAD NY
11901-2141
US

V. Phone/Fax

Practice location:
  • Phone: 631-741-4094
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF351119-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: