Provider Demographics
NPI:1578268470
Name:PEREZ, BIANCA R (PA)
Entity Type:Individual
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First Name:BIANCA
Middle Name:R
Last Name:PEREZ
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Gender:F
Credentials:PA
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Mailing Address - Street 1:251 SALINA MEADOWS PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:725 EAST ADAMS STREET
Practice Address - Street 2:4TH FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-464-5240
Practice Address - Fax:315-464-7327
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2024-03-13
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Provider Licenses
StateLicense IDTaxonomies
NY029979363A00000X, 363AM0700X, 363AS0400X
363AS0400X, 363AM0700X
NY363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical