Organization
DEVICKA PERSAUD MEDICAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEVICKA DEVI PERSAUD M.D (OWNER)
(718) 641-3389
Entity
Organization
Contact information
Practice address
11512 LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-1902
(718) 641-3389
Mailing address
11512 LIBERTY AVE, SOUTH RICHMOND HILL, NY 11419-1902
(718) 641-3389
(718) 879-6444
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
11/07/2006
Last updated
12/03/2012
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