Basic Information
| Provider Information | |||||||||
| NPI: | 1831487446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PEREZ-COSTE | ||||||||
| FirstName: | MARIA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 W 168TH ST | ||||||||
| Address2: | TRUSTEES OF COLUMBIA UNIVERSITNEUROLOGICAL INSTITUTE 12 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100323726 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129324165 | ||||||||
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| Practice Location | |||||||||
| Address1: | 541 BROADWAY | ||||||||
| Address2: | ALLEN PAVILLION | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100123944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129324165 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2011 | ||||||||
| LastUpdateDate: | 12/05/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | 274070 | NY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
No ID Information.