Provider Demographics
NPI:1518361781
Name:PEREZ, DENISE (MSED)
Entity Type:Individual
Prefix:MS
First Name:DENISE
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 1:717 125TH ST
Mailing Address - Street 2:
Mailing Address - City:COLLEGE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11356-1255
Mailing Address - Country:US
Mailing Address - Phone:718-762-6952
Mailing Address - Fax:
Practice Address - Street 1:717 125TH ST
Practice Address - Street 2:
Practice Address - City:COLLEGE POINT
Practice Address - State:NY
Practice Address - Zip Code:11356-1255
Practice Address - Country:US
Practice Address - Phone:718-762-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor