Provider Demographics
NPI:1891761334
Name:PEREZ, EVANGELINE (DO)
Entity Type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:515 84TH ST
Mailing Address - Street 2:1ST FL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-4701
Mailing Address - Country:US
Mailing Address - Phone:347-497-4984
Mailing Address - Fax:347-497-4980
Practice Address - Street 1:515 84TH ST
Practice Address - Street 2:1ST FL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4701
Practice Address - Country:US
Practice Address - Phone:347-497-4984
Practice Address - Fax:347-497-4980
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY222603207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY60D131Medicare PIN