MEDICARE: DR. ANDRES EDUARDO PEREZ CORREA MD

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	207R00000X	Internal Medicine Physician	P110512	NY

General Provider Information

NPI Number	:	1730854860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDRES EDUARDO PEREZ CORREA MD

Provider Business Mailing Address
First Line	:	2910 VALENTINE AVE APT 25A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10458-2746
Country	:	US
Telephone Number	:	646-460-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 STOCKHOLM ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11237-4194
Country	:	US
Telephone Number	:	718-508-4619
Fax Number	:

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

Provider Enumeration Date	:	08/11/2021
Last Update Date	:	08/11/2021

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