Provider Demographics
NPI:1346605789
Name:EMILIO PEREZ MEDICAL PC
Entity Type:Organization
Organization Name:EMILIO PEREZ MEDICAL PC
Other - Org Name:EP MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EMILIO
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-892-4024
Mailing Address - Street 1:345 E 94TH ST
Mailing Address - Street 2:APT 10E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5684
Mailing Address - Country:US
Mailing Address - Phone:845-241-5400
Mailing Address - Fax:
Practice Address - Street 1:90 NEW MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERSTRAW
Practice Address - State:NY
Practice Address - Zip Code:10927-1522
Practice Address - Country:US
Practice Address - Phone:845-241-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEIN