Provider Demographics
NPI:1174763270
Name:PEREZ, EDWARD (OTR)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BELMONT PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1709
Mailing Address - Country:US
Mailing Address - Phone:917-494-8499
Mailing Address - Fax:718-876-0531
Practice Address - Street 1:25 BELMONT PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1709
Practice Address - Country:US
Practice Address - Phone:917-494-8499
Practice Address - Fax:718-876-0531
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007956-1225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics