Provider Demographics
NPI:1326312802
Name:SALVADOR PEREZ MEDICAL P.C.
Entity Type:Organization
Organization Name:SALVADOR PEREZ MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SALVADOR
Authorized Official - Middle Name:ONESIMO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-761-4774
Mailing Address - Street 1:100 05 ROOSEVELT AVE
Mailing Address - Street 2:SALVADOR PEREZ MEDICAL P.C.
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368
Mailing Address - Country:US
Mailing Address - Phone:646-761-4774
Mailing Address - Fax:
Practice Address - Street 1:100 05 ROOSEVELT AVE
Practice Address - Street 2:SALVADOR PEREZ MEDICAL P.C.
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368
Practice Address - Country:US
Practice Address - Phone:646-761-4774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241980261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care