Provider Demographics
NPI:1336116177
Name:PERERA, ROHAN GERARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROHAN
Middle Name:GERARD
Last Name:PERERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:210 N BELLE MEAD RD
Mailing Address - Street 2:
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3458
Mailing Address - Country:US
Mailing Address - Phone:631-689-1400
Mailing Address - Fax:631-689-1595
Practice Address - Street 1:210 N BELLE MEAD RD
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3458
Practice Address - Country:US
Practice Address - Phone:631-689-1400
Practice Address - Fax:631-689-1595
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207987207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEX271Medicare ID - Type Unspecified
NYH16577Medicare UPIN
NY63B232Medicare ID - Type Unspecified