Provider Demographics
NPI:1578991089
Name:PERALTA PRIMARY CARE P.C.
Entity Type:Organization
Organization Name:PERALTA PRIMARY CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:FACTURA
Authorized Official - Last Name:PERALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-675-4671
Mailing Address - Street 1:30 CRESCENT PL
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-2516
Mailing Address - Country:US
Mailing Address - Phone:914-803-1151
Mailing Address - Fax:845-512-8628
Practice Address - Street 1:4310 52ND ST
Practice Address - Street 2:DAHON WELLNESS CENTER
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4542
Practice Address - Country:US
Practice Address - Phone:718-255-6229
Practice Address - Fax:718-255-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242019261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care