Provider Demographics
NPI:1205860186
Name:PERRY, JESSLYN (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSLYN
Middle Name:
Last Name:PERRY
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 1:191 NORTH STREET
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1510
Mailing Address - Country:US
Mailing Address - Phone:716-882-1200
Mailing Address - Fax:716-882-1220
Practice Address - Street 1:191 NORTH STREET
Practice Address - Street 2:SUITE 7
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14201-1510
Practice Address - Country:US
Practice Address - Phone:716-882-1200
Practice Address - Fax:716-882-1220
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210359207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0410901OtherIHA
NY000525841007OtherBS WNY
NYH08962Medicare UPIN
NYBB8655Medicare ID - Type Unspecified