Provider Demographics
NPI:1124094636
Name:PERALTA, BRIAN DAVID (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DAVID
Last Name:PERALTA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:39 VIOLET DR
Mailing Address - Street 2:
Mailing Address - City:BEACON
Mailing Address - State:NY
Mailing Address - Zip Code:12508-2217
Mailing Address - Country:US
Mailing Address - Phone:845-838-1908
Mailing Address - Fax:845-896-6882
Practice Address - Street 1:969 MAIN ST
Practice Address - Street 2:SUITE H
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1789
Practice Address - Country:US
Practice Address - Phone:845-896-6700
Practice Address - Fax:845-896-6882
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV4490152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY596948OtherAETNA INSURANCE
NY597134OtherMVP HEALTH PLAN
NY10038330OtherCDPHP
NYC31231OtherEMPIRE BC/BS
NYP768273OtherOXFORD HEALTH INS.
NY000470752001OtherHEALTHNOW OF NY
NY678489OtherUNITED HEALTHCARE
NY4C4526OtherHEALTHNET INS. NY
NY410033095OtherPALMETTO GBA-RR MEDICARE
NY597134OtherMVP HEALTH PLAN
NY4C4526OtherHEALTHNET INS. NY
NYT48982Medicare UPIN