| Devicka Persaud Medical Pc | |
|
11512 Liberty Ave South Richmond Hill NY 11419-1902 | |
| (718) 641-3389 | |
| Not Available |
| Full Name | Devicka Persaud Medical Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 11512 Liberty Ave, South Richmond Hill, New York |
| Authorized Official Name and Position | Devicka Devi Persaud (OWNER) |
| Authorized Official Contact | 7186413389 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Devicka Persaud Medical Pc 11512 Liberty Ave South Richmond Hill NY 11419-1902 Ph: (718) 641-3389 | Devicka Persaud Medical Pc 11512 Liberty Ave South Richmond Hill NY 11419-1902 Ph: (718) 641-3389 |
| NPI Number | 1407925977 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 12/03/2012 |
| Medicare PECOS PAC ID | 2264421361 |
|---|---|
| Medicare Enrollment ID | O20040701001488 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407925977 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Devicka D Persaud |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801965371 PECOS PAC ID: 9032196548 Enrollment ID: I20040702000057 |
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