Provider Demographics
NPI:1629331517
Name:PEREZ, SIDNEY (SPECIAL EDUCATOR)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:SPECIAL EDUCATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13815 FRANKLIN AVE
Mailing Address - Street 2:401
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3344
Mailing Address - Country:US
Mailing Address - Phone:917-539-3794
Mailing Address - Fax:718-358-4553
Practice Address - Street 1:13815 FRANKLIN AVE
Practice Address - Street 2:401
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3344
Practice Address - Country:US
Practice Address - Phone:917-539-3794
Practice Address - Fax:718-358-4553
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist