Provider Demographics
NPI:1578595989
Name:FELIX-PERALTA, INGRID IVANNA (MD)
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:IVANNA
Last Name:FELIX-PERALTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 ROOSEVELT AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-7911
Mailing Address - Country:US
Mailing Address - Phone:718-334-6793
Mailing Address - Fax:718-334-6717
Practice Address - Street 1:9320 ROOSEVELT AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7911
Practice Address - Country:US
Practice Address - Phone:718-334-6793
Practice Address - Fax:718-334-6717
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY180491208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics