Provider Demographics
NPI:1568095693
Name:PERSKY, SHARON M (ERYT-500)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:PERSKY
Suffix:
Gender:F
Credentials:ERYT-500
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3713
Mailing Address - Country:US
Mailing Address - Phone:516-849-5411
Mailing Address - Fax:516-432-6647
Practice Address - Street 1:201 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3713
Practice Address - Country:US
Practice Address - Phone:516-849-5411
Practice Address - Fax:516-432-6647
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service