Provider Demographics
NPI:1780922260
Name:PERALTA, EMILY (MS)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:OROPEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,
Mailing Address - Street 1:228 HAMILTON AV.
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301
Mailing Address - Country:US
Mailing Address - Phone:917-400-5646
Mailing Address - Fax:
Practice Address - Street 1:228 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1611
Practice Address - Country:US
Practice Address - Phone:917-400-5646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-17
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121223174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist