Provider Demographics
NPI:1861584724
Name:PEREIRA, BERYL ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:BERYL
Middle Name:ELIZABETH
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 182ND ST
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11423-1734
Mailing Address - Country:US
Mailing Address - Phone:718-658-0499
Mailing Address - Fax:
Practice Address - Street 1:161A N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BERGENFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07621-1739
Practice Address - Country:US
Practice Address - Phone:201-387-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH18826Medicare UPIN
NJ038766Medicare ID - Type Unspecified