Provider Demographics
NPI:1326485764
Name:PEREZ, SAMMIR ROSEMBETT (MD)
Entity Type:Individual
Prefix:
First Name:SAMMIR
Middle Name:ROSEMBETT
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 1:66-08 AUSTIN STREET APT 3-G
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4621
Mailing Address - Country:US
Mailing Address - Phone:443-624-6702
Mailing Address - Fax:
Practice Address - Street 1:6608 AUSTIN ST APT 3G
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4625
Practice Address - Country:US
Practice Address - Phone:443-624-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271399208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics