Provider Demographics
NPI:1578501698
Name:TATE, PERLA (MD)
Entity Type:Individual
Prefix:DR
First Name:PERLA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 CENTRAL AVE
Mailing Address - Street 2:MEZZANINE
Mailing Address - City:FAR ROCKAWAY
Mailing Address - State:NY
Mailing Address - Zip Code:11691-4002
Mailing Address - Country:US
Mailing Address - Phone:718-327-7969
Mailing Address - Fax:718-327-8463
Practice Address - Street 1:1624 CENTRAL AVE
Practice Address - Street 2:MEZZANINE
Practice Address - City:FAR ROCKAWAY
Practice Address - State:NY
Practice Address - Zip Code:11691-4002
Practice Address - Country:US
Practice Address - Phone:718-327-7969
Practice Address - Fax:718-327-8463
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148802207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY68278Medicaid