Provider Demographics
NPI:1558330050
Name:PERLEGIS, STAVROS (OD)
Entity Type:Individual
Prefix:DR
First Name:STAVROS
Middle Name:
Last Name:PERLEGIS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7411 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2713
Mailing Address - Country:US
Mailing Address - Phone:718-921-4827
Mailing Address - Fax:718-921-4827
Practice Address - Street 1:7411 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2713
Practice Address - Country:US
Practice Address - Phone:718-921-4827
Practice Address - Fax:718-921-4827
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005451152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01630111Medicaid
NMU50503Medicare UPIN
NYC1W32Medicare ID - Type Unspecified