Provider Demographics
NPI:1831279769
Name:PRERO, JOSHUA (MD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:
Last Name:PRERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 GLENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11581-3019
Mailing Address - Country:US
Mailing Address - Phone:516-569-3425
Mailing Address - Fax:
Practice Address - Street 1:852 GLENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11581-3019
Practice Address - Country:US
Practice Address - Phone:516-569-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN005974213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NYU96955Medicare UPIN
NYPJ1381Medicare PIN
NY00330231Medicare ID - Type Unspecified
NYPJ1381Medicare UPIN
NY05916AMedicare PIN