Individual
ANISA ALI-PEREZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
640 HAWKINS AVE, LAKE RONKONKOMA, NY 11779-2324
(631) 737-0100
(631) 417-1117
Mailing address
1000 ZECKENDORF BLVD, GARDEN CITY, NY 11530-2133
(516) 542-6880
(516) 542-5556
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001915
NY
Other
Enumeration date
06/05/2006
Last updated
10/05/2011
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