Doctor Name: | JERRY A PEREZ |
NPI Number: | 1093845166 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | CCC-SLP |
License Number: | 021185 |
Business Practice Address: | 3962 64th St Woodside, NY - 113773651 |
Business Phone Number: | 3472623626 |
Business Fax Number: | |
Mailing Address: | Po Box 770962, WOODSIDE |
State: | NY |
Postal Code: | 113770962 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/06/2007 |
NPI Last Update Date: | 09/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 021185 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |