Provider Demographics
NPI:1578616785
Name:OMOYON-PERHAM, MARILOU MIRA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARILOU
Middle Name:MIRA
Last Name:OMOYON-PERHAM
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Gender:F
Credentials:NP
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Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:ISLAND NEONATOLOGY PLLC
Mailing Address - City:EAST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11730-0272
Mailing Address - Country:US
Mailing Address - Phone:631-224-1878
Mailing Address - Fax:631-224-7963
Practice Address - Street 1:200 BELLE TERRE RD
Practice Address - Street 2:INTENSIVE CARE NURSERY
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-1928
Practice Address - Country:US
Practice Address - Phone:631-474-6577
Practice Address - Fax:631-474-6356
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NYF350156-1363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal