Provider Demographics
NPI:1720530801
Name:PEREZ, F MARLENE (MD)
Entity Type:Individual
Prefix:DR
First Name:F
Middle Name:MARLENE
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 1:10 STEWART PL APT 10CW
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-7012
Mailing Address - Country:US
Mailing Address - Phone:914-946-2044
Mailing Address - Fax:
Practice Address - Street 1:10 STEWART PL APT 10CW
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-7012
Practice Address - Country:US
Practice Address - Phone:914-946-2044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-25
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188382174400000X
CT037148174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY205211Medicare UPIN