Provider Demographics
NPI:1477708741
Name:PERCONTRA, CARMELA (RN, MS, CLT)
Entity Type:Individual
Prefix:MS
First Name:CARMELA
Middle Name:
Last Name:PERCONTRA
Suffix:
Gender:F
Credentials:RN, MS, CLT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TROUTMAN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11206-6105
Mailing Address - Country:US
Mailing Address - Phone:917-292-7198
Mailing Address - Fax:
Practice Address - Street 1:2235 CLOVE RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-1566
Practice Address - Country:US
Practice Address - Phone:718-815-8100
Practice Address - Fax:718-815-8200
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-29
Last Update Date:2010-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381550172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker