MEDICARE: JACQUELINE 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		NY

General Provider Information

NPI Number	:	1689025967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE PEREZ

Provider Business Mailing Address
First Line	:	4507 WHISPERING HILLS
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918
Country	:	US
Telephone Number	:	914-469-7941
Fax Number	:

Provider Business Practice Location Address
First Line	:	4507 WHISPERING HILLS
Second Line	:
City	:	CHESTER
State	:	NY
Zip	:	10918
Country	:	US
Telephone Number	:	914-469-7941
Fax Number	:

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

Provider Enumeration Date	:	06/28/2016
Last Update Date	:	06/28/2016

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Directions to “ JACQUELINE PEREZ ” Practice Location

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