Provider Demographics
NPI:1497704159
Name:JOSEPH T PERILLO D P M
Entity Type:Organization
Organization Name:JOSEPH T PERILLO D P M
Other - Org Name:FINGER LAKES PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:KYLE
Authorized Official - Last Name:PERILLO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:315-789-8132
Mailing Address - Street 1:650 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1334
Mailing Address - Country:US
Mailing Address - Phone:315-789-8132
Mailing Address - Fax:315-789-8136
Practice Address - Street 1:650 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-789-8132
Practice Address - Fax:315-789-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10879AMedicare PIN
NY0550530001Medicare NSC