Provider Demographics
NPI:1417942202
Name:PERLMUTTER, HALE I (RPAC)
Entity Type:Individual
Prefix:
First Name:HALE
Middle Name:I
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:HALE
Other - Middle Name:
Other - Last Name:IMRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DR
Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:BUILDING 1 PSYCHIATRY
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1138
Mailing Address - Country:US
Mailing Address - Phone:718-918-6739
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BUILDING 1 PSYCHIATRY
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1138
Practice Address - Country:US
Practice Address - Phone:718-918-6739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2797363A00000X
NY12421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00027074OtherRAILROAD MEDICARE
P91119Medicare UPIN
OK200010100AMedicaid
P91119Medicare UPIN