Provider Demographics
NPI:1477817591
Name:ELLEN PERLIN MARTIN
Entity Type:Organization
Organization Name:ELLEN PERLIN MARTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TEACHER OF SPEECH AND HEARING
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLIN MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-991-8617
Mailing Address - Street 1:81 BEACON HILL RD
Mailing Address - Street 2:
Mailing Address - City:ARDSLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10502-1632
Mailing Address - Country:US
Mailing Address - Phone:914-674-4263
Mailing Address - Fax:
Practice Address - Street 1:81 BEACON HILL RD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1632
Practice Address - Country:US
Practice Address - Phone:914-674-4263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center