Provider Demographics
NPI:1376551606
Name:MARINA PERLOVA MEDICAL PC
Entity Type:Organization
Organization Name:MARINA PERLOVA MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-265-3003
Mailing Address - Street 1:183 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1910
Mailing Address - Country:US
Mailing Address - Phone:718-265-3003
Mailing Address - Fax:718-265-1807
Practice Address - Street 1:2327 83RD ST
Practice Address - Street 2:SUITE C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-2750
Practice Address - Country:US
Practice Address - Phone:718-265-3003
Practice Address - Fax:718-265-1807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2008-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWDP521Medicare PIN