Provider Demographics
NPI:1629389325
Name:FLUSHING FAMILY & MEDICAL PRACTICE PC
Entity Type:Organization
Organization Name:FLUSHING FAMILY & MEDICAL PRACTICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:PERALTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-460-1681
Mailing Address - Street 1:14420 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-1331
Mailing Address - Country:US
Mailing Address - Phone:718-460-1681
Mailing Address - Fax:
Practice Address - Street 1:14420 29TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-1331
Practice Address - Country:US
Practice Address - Phone:718-460-1681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195347208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01523275Medicaid
1629389325OtherNPI
01579OtherP10
G00921Medicare UPIN