MEDICARE: MR. EMILIANO PEREZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	174400000X	Specialist		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	174400000X-SPECIALIS	OTHER	NY	SERVICE PROVIDER

General Provider Information

NPI Number	:	1235493685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EMILIANO PEREZ

Provider Business Mailing Address
First Line	:	3614 IRWIN AVE
Second Line	:	1-FL
City	:	BRONX
State	:	NY
Zip	:	10463-2214
Country	:	US
Telephone Number	:	646-294-9105
Fax Number	:

Provider Business Practice Location Address
First Line	:	3614 IRWIN AVE
Second Line	:	1-FL
City	:	BRONX
State	:	NY
Zip	:	10463-2214
Country	:	US
Telephone Number	:	646-294-9105
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2012
Last Update Date	:	06/30/2012

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Directions to “ MR. EMILIANO PEREZ ” Practice Location

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