Provider Demographics
NPI:1578525408
Name:PERRONE, PAOLO G (MD)
Entity Type:Individual
Prefix:DR
First Name:PAOLO
Middle Name:G
Last Name:PERRONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305-2080
Mailing Address - Country:US
Mailing Address - Phone:718-448-6800
Mailing Address - Fax:718-448-9458
Practice Address - Street 1:800 MANOR RD
Practice Address - Street 2:SUITE 4
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7034
Practice Address - Country:US
Practice Address - Phone:718-448-6800
Practice Address - Fax:718-448-9458
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY214346207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02050700Medicaid
NYH05969Medicare UPIN
NY07913HMedicare PIN
NY834191Medicare PIN
NY02050700Medicaid