Provider Demographics
NPI:1700333424
Name:PEREZ, BEREMIS CRISTIAN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BEREMIS
Middle Name:CRISTIAN
Last Name:PEREZ
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 BROAD ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013-1645
Mailing Address - Country:US
Mailing Address - Phone:973-246-9355
Mailing Address - Fax:
Practice Address - Street 1:716 BROAD ST STE 1E
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013-1645
Practice Address - Country:US
Practice Address - Phone:973-246-9355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-10
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01721900225100000X
NY040809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQDW011OtherMEDICARE IDENTIFICATION NUMBER