Provider Demographics
NPI:1811913452
Name:PEREA, ANNETTE (MD)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:PEREA
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 1:4008 FORLEY STREET
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1493
Mailing Address - Country:US
Mailing Address - Phone:718-446-0270
Mailing Address - Fax:718-446-5939
Practice Address - Street 1:4008 FORLEY ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1427
Practice Address - Country:US
Practice Address - Phone:718-446-0270
Practice Address - Fax:718-446-5939
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225537208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02356572Medicaid
NY05515Medicare ID - Type Unspecified
NY02356572Medicaid