Provider Demographics
NPI:1215906078
Name:PEREZ, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4915 BROADWAY
Mailing Address - Street 2:SUITE #1G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-3119
Mailing Address - Country:US
Mailing Address - Phone:914-525-7637
Mailing Address - Fax:212-544-0402
Practice Address - Street 1:4915 BROADWAY
Practice Address - Street 2:SUITE #1G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-3119
Practice Address - Country:US
Practice Address - Phone:212-544-9513
Practice Address - Fax:212-544-0402
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY170543207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01196487Medicaid
NYP00633190Medicare PIN
NY56F781Medicare PIN