Anisa Ali-Perez, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

001915 Issued in NY

Practice address

640 Hawkins Ave
Lake Ronkonkoma, NY 11779-2324

Phone

(631) 737-0100

Fax

(631) 417-1117

NPI assigned

Jun 5, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1255370540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 ZECKENDORF BLVD",
            "city": "GARDEN CITY",
            "state": "NY",
            "postal_code": "115302133",
            "telephone_number": "516-542-6880",
            "fax_number": "516-542-5556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 HAWKINS AVE",
            "city": "LAKE RONKONKOMA",
            "state": "NY",
            "postal_code": "117792324",
            "telephone_number": "631-737-0100",
            "fax_number": "631-417-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALI-PEREZ",
        "first_name": "ANISA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-05",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "001915",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Abbott, RN
• Frank Thomas Adam, O.D.
• Salma Afroze, DO
• Dawn Marie Agnese Diaz, PT
• Khadiga Ahmed, DO
• Sabrina Amature
• Patricia Auletta
• Michelle Bagliore
• Julianne Bartlett, M.ED., CAS
• Carmela Bayer, PA-C

• Physician Assistant in Lake Ronkonkoma, NY
• Providers in Lake Ronkonkoma, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.