Provider Demographics
NPI:1104024314
Name:PEREZ, SALVADOR O (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:O
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:9902 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2451
Mailing Address - Country:US
Mailing Address - Phone:347-201-4567
Mailing Address - Fax:718-779-1470
Practice Address - Street 1:10005 ROOSEVELT AVE STE 201
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-4880
Practice Address - Country:US
Practice Address - Phone:347-201-4567
Practice Address - Fax:718-779-1470
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2012-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY241980207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02872273Medicaid
NY08091GMedicare PIN