Organization · NPI-2

Devicka Persaud Medical PC

Family Medicine · South Richmond Hill, NY

NPI number1407925977
StatusActive
Last updated in NPPESDec 3, 2012

Details

NPI
1407925977
Entity type
Organization (NPI-2)
Legal business name
Devicka Persaud Medical PC
Organization subpart
No
Enumeration date
Nov 7, 2006
Last updated
Dec 3, 2012

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine––Yes

Practice location

11512 Liberty Ave
South Richmond Hill, NY 11419-1902

Phone 718-641-3389

Mailing address

11512 Liberty Ave
South Richmond Hill, NY 11419-1902

Phone 718-641-3389 · Fax 718-879-6444

Authorized official

Devicka Devi Persaud
Owner
7186413389

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