Provider Demographics
NPI:1043200827
Name:PEREZ, MANUEL GARCIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:GARCIA
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 1:183 MAMARONECK RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4527
Mailing Address - Country:US
Mailing Address - Phone:914-723-8779
Mailing Address - Fax:
Practice Address - Street 1:531 E 138TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10454-3087
Practice Address - Country:US
Practice Address - Phone:718-993-5959
Practice Address - Fax:718-993-5959
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
12 01134OtherUNITED HEALTHCARE
NY0082663OtherGHI
NY2C5916OtherHEALTH NET
NY00207254Medicaid
113690OtherHIP
0501228OtherUS HEALTHCARE
4564361OtherAETNA PPO
MP20 00884OtherMETROPLUS
207466OtherWELLCARE
113690 A19OtherHEALTH FIRST
113690 A19OtherHEALTH FIRST
NY00207254Medicaid