Provider Demographics
NPI:1528540564
Name:PERLOFF, MELISSA LEIGH
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LEIGH
Last Name:PERLOFF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2632 NATIONAL DR
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6917
Mailing Address - Country:US
Mailing Address - Phone:516-458-0895
Mailing Address - Fax:
Practice Address - Street 1:2632 NATIONAL DR
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-6917
Practice Address - Country:US
Practice Address - Phone:516-458-0895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1240302181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist