Provider Demographics
NPI:1578520862
Name:PEREIRA, FREDERICK ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:ANDREW
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 1:51-14 KISSENA BLVD
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-4163
Mailing Address - Country:US
Mailing Address - Phone:718-359-4425
Mailing Address - Fax:718-359-3729
Practice Address - Street 1:51-14 KISSENA BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-4163
Practice Address - Country:US
Practice Address - Phone:718-359-4425
Practice Address - Fax:718-359-3729
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103733207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00180043Medicaid
NY70612Medicare PIN
C12464Medicare UPIN
706125107Medicare ID - Type Unspecified