Provider Demographics
NPI:1124184874
Name:PERERA, JULIAN PATRICK (MSC CRC CASALT)
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:PATRICK
Last Name:PERERA
Suffix:
Gender:M
Credentials:MSC CRC CASALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:143 EAST 43 STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10017
Mailing Address - Country:US
Mailing Address - Phone:212-867-8850
Mailing Address - Fax:
Practice Address - Street 1:500 EIGHT AVENUE
Practice Address - Street 2:DAYTOP VILLAGE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018
Practice Address - Country:US
Practice Address - Phone:212-904-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health