Provider Demographics
NPI:1366625931
Name:FRANK B PERILLO DPM
Entity Type:Organization
Organization Name:FRANK B PERILLO DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:PERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:716-838-1131
Mailing Address - Street 1:1431 HERTEL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2826
Mailing Address - Country:US
Mailing Address - Phone:716-838-1131
Mailing Address - Fax:716-838-1158
Practice Address - Street 1:1431 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2826
Practice Address - Country:US
Practice Address - Phone:716-838-1131
Practice Address - Fax:716-838-1158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002894332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0922450001Medicare NSC