Provider Demographics
NPI:1174947626
Name:PEREZ, SUSAN A (MASTERS IN EDUCATION)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:F
Credentials:MASTERS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11516 114TH PL
Mailing Address - Street 2:
Mailing Address - City:SOUTH OZONE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11420-2301
Mailing Address - Country:US
Mailing Address - Phone:917-868-2075
Mailing Address - Fax:
Practice Address - Street 1:11516 114TH PL
Practice Address - Street 2:
Practice Address - City:SOUTH OZONE PARK
Practice Address - State:NY
Practice Address - Zip Code:11420-2301
Practice Address - Country:US
Practice Address - Phone:917-868-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY704738131174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist