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General NPI Number Information
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NPI Number | 1386312858
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Entity Type | Individual
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Provider Name | JOHN PERECA PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 989 W JERICHO TPKE
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City | SMITHTOWN
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State | NY
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Zip | 11787-3241
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Country | US
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Telephone | 631-796-7971
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Fax |
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Provider Business Mailing Address
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Address Line | 16 PINECONE LN
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City | COMMACK
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State | NY
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Zip | 11725-4706
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Country | US
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Telephone |
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 027146
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License Number State | NY
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