Provider Demographics
NPI:1245391812
Name:PERELMAN, MICHAEL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:PERELMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 E 77TH ST
Mailing Address - Street 2:SUITE #1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-1811
Mailing Address - Country:US
Mailing Address - Phone:212-570-5000
Mailing Address - Fax:212-570-2288
Practice Address - Street 1:70 E 77TH ST
Practice Address - Street 2:SUITE #1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-1811
Practice Address - Country:US
Practice Address - Phone:212-570-5000
Practice Address - Fax:212-570-2288
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5428103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV2165100Medicare ID - Type Unspecified