Provider Demographics
NPI:1285869677
Name:HEALTH DEVELOPMENT & RESTORATIVE MEDICINE, PC
Entity type:Organization
Organization Name:HEALTH DEVELOPMENT & RESTORATIVE MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-682-5163
Mailing Address - Street 1:1469 BEACH AVE
Mailing Address - Street 2:MEDICAL OFFICE
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460-3630
Mailing Address - Country:US
Mailing Address - Phone:347-810-9001
Mailing Address - Fax:
Practice Address - Street 1:1469 BEACH AVE
Practice Address - Street 2:MEDICAL OFFICE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10460-3630
Practice Address - Country:US
Practice Address - Phone:347-810-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TB0200X, 133N00000X, 133NN1002X, 133V00000X, 213E00000X
NY231817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100017863OtherMEDICARE PTAN