Provider Demographics
NPI:1053570556
Name:EVANGELINE PEREZ DO PC
Entity type:Organization
Organization Name:EVANGELINE PEREZ DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EVANGELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:347-497-4984
Mailing Address - Street 1:515 84TH ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4701
Mailing Address - Country:US
Mailing Address - Phone:347-497-4984
Mailing Address - Fax:347-497-4980
Practice Address - Street 1:515 84TH ST
Practice Address - Street 2:1ST FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4701
Practice Address - Country:US
Practice Address - Phone:347-497-4984
Practice Address - Fax:347-497-4980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222603207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty