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General NPI Number Information
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NPI Number | 1225390578
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Entity Type | Individual
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Provider Name | MRS. ELIZABETH M PEREZ
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Gender | Female
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Dates
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Enumeration Date | 06/12/2012
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Last Update Date | 06/12/2012
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Provider Practice Location Address
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Address Line | 3711 35TH AVE
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City | ASTORIA
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State | NY
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Zip | 11101-1524
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Country | US
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Telephone | 718-706-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 10 HAMILTON LN
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City | CHESTNUT RIDGE
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State | NY
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Zip | 10977-7008
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Country | US
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Telephone | 646-249-4387
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State | NY
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