Provider Demographics
NPI:1336143742
Name:PERRY, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6932 WILLIAMS RD
Mailing Address - Street 2:STE 1700
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3072
Mailing Address - Country:US
Mailing Address - Phone:716-297-7040
Mailing Address - Fax:716-297-7048
Practice Address - Street 1:6932 WILLIAMS RD
Practice Address - Street 2:STE 1700
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3072
Practice Address - Country:US
Practice Address - Phone:716-297-7040
Practice Address - Fax:716-297-7048
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152856-1BOtherWORKERS' COMP/NO FAULT
240003341OtherRAIL ROAD MEDICARE
NY000500003012OtherCOMMUNITY BLUE NIAGARA FA
NY00010137003OtherUNIVERA
NY000500003011OtherCOMMUNITY BLUE BUFFALO OF
NY1004027OtherINDEPENDENT HEALTH
NY00755784Medicaid
NY0700126OtherGHI
NY000500003011OtherCOMMUNITY BLUE BUFFALO OF