Provider Demographics
NPI:1902864234
Name:PEREZ, BRENDA LEE (MD/MBA)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:LEE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MD/MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1903
Mailing Address - Country:US
Mailing Address - Phone:716-298-3000
Mailing Address - Fax:
Practice Address - Street 1:5300 MILITARY ROAD
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092
Practice Address - Country:US
Practice Address - Phone:716-297-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232452207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110713000116OtherFIDELIS
000928936007OtherBCBS OF WNY
NY00355266Medicaid
NY02675872Medicaid
NYI46511Medicare UPIN
NY00355266Medicaid
NYRB1131-GRP:70008AMedicare PIN
NYRB1131Medicare PIN