Provider Demographics
NPI:1508823600
Name:PERSKY, SETH EVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:EVAN
Last Name:PERSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3400 NESCONSET HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3327
Mailing Address - Country:US
Mailing Address - Phone:631-751-8700
Mailing Address - Fax:631-751-5971
Practice Address - Street 1:3400 NESCONSET HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3327
Practice Address - Country:US
Practice Address - Phone:631-751-8700
Practice Address - Fax:631-751-5971
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY213007207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02120827Medicaid
NY28B181Medicare ID - Type Unspecified
NY02120827Medicaid