Provider Demographics
NPI:1891732772
Name:BESADA, INACIA PEREZ (MD)
Entity Type:Individual
Prefix:DR
First Name:INACIA
Middle Name:PEREZ
Last Name:BESADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2018
Mailing Address - Country:US
Mailing Address - Phone:516-739-1040
Mailing Address - Fax:
Practice Address - Street 1:99 DIVISION AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6620
Practice Address - Country:US
Practice Address - Phone:718-599-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232667208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02296660Medicaid
NYI01150Medicare UPIN
NY02296660Medicaid