Peralta Primary Care P.C.

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

242019 Issued in NY

Legal business name

PERALTA PRIMARY CARE P.C.

Practice address

4310 52ND St
Dahon Wellness Center
Woodside, NY 11377-4542

Phone

(718) 255-6229

Fax

(718) 255-1288

NPI assigned

Oct 18, 2013

Last updated

Oct 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Mark Factura Peralta, M.D.NPI 1326186651

Title

Owner

Phone

(646) 675-4671

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark F Peralta, MD

  • Internal Medicine Physician
  • Suffern, NY
  • NPI 1326186651
  NPD (past) Authorized official

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

{
    "created_epoch": "1382054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382054400000",
    "number": "1578991089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CRESCENT PL",
            "city": "YONKERS",
            "state": "NY",
            "postal_code": "107042516",
            "telephone_number": "914-803-1151",
            "fax_number": "845-512-8628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 52ND ST",
            "address_2": "DAHON WELLNESS CENTER",
            "city": "WOODSIDE",
            "state": "NY",
            "postal_code": "113774542",
            "telephone_number": "718-255-6229",
            "fax_number": "718-255-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERALTA PRIMARY CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-18",
        "last_updated": "2013-10-18",
        "status": "A",
        "authorized_official_last_name": "PERALTA",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "FACTURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "646-675-4671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NY",
            "license": "242019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Pelaez, LMFT
• Robert Vincent Pena Diaz, MS.ED
• Crystal Pena, PTA
• Melissa Pena
• Khea Mel Estorninos Perales, PTA
• Marina C Peralta, BSN, RN, CCTN
• Cynthia Perez, MSED
• Jerry A Perez, CCC-SLP
• Rony Saolyn Perez
• Sylvia Perez

• Primary Care Clinic/Center in Woodside, NY
• Providers in Woodside, NY by specialty
• Primary Care Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2013; 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.