Provider Demographics
NPI:1205111226
Name:PEREZ, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 VAN CORTLANDT PARK S
Mailing Address - Street 2:#6C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2922
Mailing Address - Country:US
Mailing Address - Phone:646-387-5656
Mailing Address - Fax:
Practice Address - Street 1:92 VAN CORTLANDT PARK S
Practice Address - Street 2:#6C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-2922
Practice Address - Country:US
Practice Address - Phone:646-387-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020614-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY658026061OtherTSSLD LICENCE