Provider Demographics
NPI:1063435972
Name:PEREZ, WALTER HERNAN (DPM)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:HERNAN
Last Name:PEREZ
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 FLATBUSH AVE MEDICAL OFFICE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-4903
Mailing Address - Country:US
Mailing Address - Phone:718-675-1100
Mailing Address - Fax:877-868-8633
Practice Address - Street 1:595 FLATBUSH AVE MEDICAL OFFICE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-5406
Practice Address - Country:US
Practice Address - Phone:718-675-1100
Practice Address - Fax:877-868-8633
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005554213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01948030Medicaid
NY02519726Medicaid
NY6299151OtherGHI
NYN005554OtherHIP
NY010012305OtherUNITED HEALTH CARE
NY10204538OtherAMERIGROUP NEW YORK, LLC
NY54N2182OtherNHP NEIGHBORHOOD
NYP2734169OtherOXFORD HEALTH PLAN
NY109930101OtherHEALTH PLUS
NY74-3048941OtherHORIZON HEALTH CARE
NY0100112305OtherAMERICHOICE BY UNITED HEALTH CARE
NY113513164OtherMETROPLUS
NY74-3048941OtherMAGNA CARE
NYN005554-A22OtherHEALTH FIRST
NY170647OtherELDERPLAN
NY92067OtherWELLCARE
NY4C4325OtherHEALTH NET
NY74-3048941OtherHORIZON HEALTH CARE
NY170647OtherELDERPLAN
NY02519726Medicaid
NY4732120001Medicare NSC
NYPQW201Medicare PIN
NY74-3048941OtherMAGNA CARE