Provider Demographics
NPI:1275873267
Name:PERILLI, MARIA SUSAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:SUSAN
Last Name:PERILLI
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 WESTFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1545
Mailing Address - Country:US
Mailing Address - Phone:631-488-8548
Mailing Address - Fax:
Practice Address - Street 1:56 WESTFIELD DR
Practice Address - Street 2:
Practice Address - City:CENTERPORT
Practice Address - State:NY
Practice Address - Zip Code:11721-1545
Practice Address - Country:US
Practice Address - Phone:631-488-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263386-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse