Provider Demographics
NPI:1689895989
Name:PEREZ, AMEET KAUR (PA)
Entity Type:Individual
Prefix:MRS
First Name:AMEET
Middle Name:KAUR
Last Name:PEREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 MIDDLE COUNTRY RD STE 228
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2873
Mailing Address - Country:US
Mailing Address - Phone:631-265-1351
Mailing Address - Fax:
Practice Address - Street 1:222 MIDDLE COUNTRY RD STE 228
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2873
Practice Address - Country:US
Practice Address - Phone:631-265-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant