Provider Demographics
NPI:1578010559
Name:PERRY, PAULETTE JOYCE I
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:JOYCE
Last Name:PERRY
Suffix:I
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:PAULETTE
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13756 232ND ST
Mailing Address - Street 2:
Mailing Address - City:LAURELTON
Mailing Address - State:NY
Mailing Address - Zip Code:11413-2835
Mailing Address - Country:US
Mailing Address - Phone:347-306-5085
Mailing Address - Fax:
Practice Address - Street 1:13756 232 STREET
Practice Address - Street 2:
Practice Address - City:LAURELTON
Practice Address - State:NY
Practice Address - Zip Code:11413
Practice Address - Country:US
Practice Address - Phone:347-306-5085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNONE174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist