Healthcare Provider Details

I. General information

NPI: 1376436097
Provider Name (Legal Business Name): RANDY PEREZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 E POST RD
WHITE PLAINS NY
10601-4607
US

IV. Provider business mailing address

100 COLLEGE AVE APT H10
SLEEPY HOLLOW NY
10591-2838
US

V. Phone/Fax

Practice location:
  • Phone: 914-681-0600
  • Fax:
Mailing address:
  • Phone: 914-525-5872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number850663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: