Provider Demographics
NPI:1164851580
Name:PEREIRA, JACQUELINE
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MORRIS PARK AVE
Mailing Address - Street 2:SUITE 2-B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1400
Mailing Address - Country:US
Mailing Address - Phone:718-409-6977
Mailing Address - Fax:718-409-6946
Practice Address - Street 1:1120 MORRIS PARK AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1400
Practice Address - Country:US
Practice Address - Phone:718-409-6977
Practice Address - Fax:718-409-6946
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator