Provider Demographics
NPI:1881075729
Name:PEREZ PIMENTEL, SUZANA MERCEDES
Entity type:Individual
Prefix:MISS
First Name:SUZANA
Middle Name:MERCEDES
Last Name:PEREZ PIMENTEL
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 1:59 E MAIN ST
Mailing Address - Street 2:APT 19
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-8332
Mailing Address - Country:US
Mailing Address - Phone:516-724-5282
Mailing Address - Fax:
Practice Address - Street 1:59 E MAIN ST
Practice Address - Street 2:APT 19
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-8332
Practice Address - Country:US
Practice Address - Phone:516-724-5282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No252Y00000XAgenciesEarly Intervention Provider Agency