Provider Demographics
NPI:1003953852
Name:PEREZ, STEPHEN BARNES (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BARNES
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225A E 149TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-5551
Mailing Address - Country:US
Mailing Address - Phone:718-466-9200
Mailing Address - Fax:718-466-9444
Practice Address - Street 1:225A E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5551
Practice Address - Country:US
Practice Address - Phone:718-466-9200
Practice Address - Fax:718-466-9444
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217461207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02064675Medicaid
NY02064675Medicaid
NY59C401Medicare ID - Type Unspecified