Provider Demographics
NPI:1477822328
Name:PEREZ, CYNTHIA (MSED)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 69TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7541
Mailing Address - Country:US
Mailing Address - Phone:347-242-2580
Mailing Address - Fax:
Practice Address - Street 1:5050 69TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7541
Practice Address - Country:US
Practice Address - Phone:347-242-2580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY397991101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist