1952728255 NPI number — MRS. FRANCES JOHANNA PEREDO FNP

Table of content: MRS. FRANCES JOHANNA PEREDO FNP (NPI 1952728255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952728255 NPI number — MRS. FRANCES JOHANNA PEREDO FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEREDO
Provider First Name:
FRANCES
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KHAN
Provider Other First Name:
AIJAZ
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952728255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
187 DOT CT E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11572-5920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-764-3310
Provider Business Mailing Address Fax Number:
516-766-0918

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
187 DOT CT E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11572-5920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-764-3310
Provider Business Practice Location Address Fax Number:
516-766-0918
Provider Enumeration Date:
03/25/2014

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: 363LF0000X , with the licence number:  338588 , 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)





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