Provider Demographics
NPI:1053491829
Name:PERLMUTTER, ILISSE ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ILISSE
Middle Name:ROBIN
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 E 80TH ST
Mailing Address - Street 2:APT PH-F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0450
Mailing Address - Country:US
Mailing Address - Phone:212-744-1019
Mailing Address - Fax:
Practice Address - Street 1:178 E 80TH ST
Practice Address - Street 2:APT PH-F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0450
Practice Address - Country:US
Practice Address - Phone:212-744-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2010-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1638122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY0033S128Medicare ID - Type Unspecified
NY00246075Medicaid