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General NPI Number Information
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NPI Number | 1649980459
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Entity Type | Organization
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Legal Business Name | ANDREW PEREDO, MD, PC
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Dates
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Enumeration Date | 12/02/2022
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 1047 PARK AVE
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City | NEW YORK
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State | NY
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Zip | 10028-1002
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Country | US
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Telephone | 212-754-6363
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Fax | 646-582-1440
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Provider Business Mailing Address
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Address Line | 594 VANDERBILT PKWY
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City | DIX HILLS
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State | NY
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Zip | 11746-5527
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Country | US
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Telephone | 212-754-6363
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW PEREDO
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Credential | MD
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Telephone | 917-828-5523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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