Provider Demographics
NPI:1497824817
Name:PEREIRA, ANDRES MIGUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDRES
Middle Name:MIGUEL
Last Name:PEREIRA
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 1:105 ARDEN ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-1118
Mailing Address - Country:US
Mailing Address - Phone:212-567-6200
Mailing Address - Fax:212-567-9397
Practice Address - Street 1:105 ARDEN ST STE 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10040-1118
Practice Address - Country:US
Practice Address - Phone:212-567-6200
Practice Address - Fax:212-567-9397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173568208000000X, 207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01072586Medicaid
NY01072586Medicaid
NY01072586Medicaid