Provider Demographics
NPI:1336236769
Name:PEREZ, DESIREE CONSUELO (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:CONSUELO
Last Name:PEREZ
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 1:127 WOODSIDE AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-1461
Mailing Address - Country:US
Mailing Address - Phone:914-762-2276
Mailing Address - Fax:914-762-2894
Practice Address - Street 1:127 WOODSIDE AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-1461
Practice Address - Country:US
Practice Address - Phone:914-762-2276
Practice Address - Fax:914-762-2894
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168116208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336236739Medicare NSC