1063435972 NPI number — DR. WALTER HERNAN PEREZ D.P.M.

Table of content: DR. WALTER HERNAN PEREZ D.P.M. (NPI 1063435972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063435972 NPI number — DR. WALTER HERNAN PEREZ D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREZ
Provider First Name:
WALTER
Provider Middle Name:
HERNAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063435972
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
595 FLATBUSH AVE MEDICAL OFFICE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11225-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-675-1100
Provider Business Mailing Address Fax Number:
877-868-8633

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
595 FLATBUSH AVE MEDICAL OFFICE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11225-5406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-675-1100
Provider Business Practice Location Address Fax Number:
877-868-8633
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  N005554 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01948030 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02519726 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6299151 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N005554 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 010012305 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10204538 . This is a "AMERIGROUP NEW YORK, LLC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 54N2182 . This is a "NHP NEIGHBORHOOD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2734169 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 109930101 . This is a "HEALTH PLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 74-3048941 . This is a "HORIZON HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0100112305 . This is a "AMERICHOICE BY UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113513164 . This is a "METROPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 74-3048941 . This is a "MAGNA CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: N005554-A22 . This is a "HEALTH FIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 170647 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 92067 . This is a "WELLCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C4325 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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