Provider Demographics
NPI:1962723924
Name:PERSAUD, BIANCA (MD)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:PERSAUD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:FELICIA
Other - Last Name:DELACRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:220 13TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4802
Mailing Address - Country:US
Mailing Address - Phone:718-832-1916
Mailing Address - Fax:718-832-5991
Practice Address - Street 1:220 13TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4802
Practice Address - Country:US
Practice Address - Phone:718-832-1916
Practice Address - Fax:718-832-5991
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271312207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine