Organization
EXCELLA MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL PEREZ (MD)
(212) 544-9513
Entity
Organization
Contact information
Practice address
4915 BROADWAY, SUITE 1G, NEW YORK, NY 10034-3119
(212) 544-9513
(212) 544-0402
Mailing address
4915 BROADWAY, SUITE 1G, NEW YORK, NY 10034-3119
(212) 544-9513
(212) 544-0402
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
170543
NY
207RN0300X
Nephrology Physician
170543
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01196487
—
NY
01
—
P00633190
MEDICARE RAILROAD
NY
Enumeration date
04/04/2011
Last updated
04/04/2011
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