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General NPI Number Information
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NPI Number | 1427026392
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Entity Type | Organization
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Legal Business Name | MARINA I PEREDO MD PC
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 260 MIDDLE COUNTRY RD STE 208
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-863-3223
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Fax | 631-863-3334
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Provider Business Mailing Address
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Address Line | 260 MIDDLE COUNTRY RD STE 208
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City | SMITHTOWN
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State | NY
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Zip | 11787
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Country | US
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Telephone | 631-863-3223
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Fax | 631-863-3334
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | MRS. MARINA I PEREDO
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Credential | MD PC
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Telephone | 631-863-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 190716
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License Number State | NY
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