Provider Demographics
NPI:1760465371
Name:PEREZ, CARLOS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1145 TARGEE STREET
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10304
Mailing Address - Country:US
Mailing Address - Phone:718-668-6900
Mailing Address - Fax:718-668-6900
Practice Address - Street 1:1704 MERMAID AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2622
Practice Address - Country:US
Practice Address - Phone:718-265-0900
Practice Address - Fax:718-265-6319
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY097912207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01467349Medicaid
NY01467349Medicaid
NY525571Medicare PIN