Provider Demographics
NPI:1528034428
Name:DRUCKER, PERRY DEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:DEAN
Last Name:DRUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 EDISON ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10306-3043
Mailing Address - Country:US
Mailing Address - Phone:718-980-0101
Mailing Address - Fax:718-980-1641
Practice Address - Street 1:361 EDISON ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10306-3043
Practice Address - Country:US
Practice Address - Phone:718-980-0101
Practice Address - Fax:718-980-1641
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182903208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01433825Medicaid
NYF20395Medicare UPIN
NY01433825Medicaid