Provider Demographics
NPI:1396821658
Name:PERRIE, ANTOINETTE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:
Last Name:PERRIE
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19906 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3952
Mailing Address - Country:US
Mailing Address - Phone:718-224-0444
Mailing Address - Fax:718-264-1118
Practice Address - Street 1:19906 47TH AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-3952
Practice Address - Country:US
Practice Address - Phone:718-224-0444
Practice Address - Fax:718-264-1118
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-30
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX002812-1111N00000X
NY001000-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP641219OtherOXFORD/CHIRO NUMBER
NYC002812-8BOtherNY WORKER COMP ID NUMBER
NYP2527946OtherOXFORD/ACUPUNCTURE #
NYX3041OtherBLUE CROSS/BLUE SHIELD
NY4295277OtherAETNA ID NUMBER
NYP2527946OtherOXFORD/ACUPUNCTURE #
NY79509Medicare ID - Type UnspecifiedMEDICARE NUMBER