Provider Demographics
NPI:1588806863
Name:PERRY PHYSICAL MEDICINE & REHABILITATION, P.C.
Entity Type:Organization
Organization Name:PERRY PHYSICAL MEDICINE & REHABILITATION, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:631-586-3700
Mailing Address - Street 1:2033 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2109
Mailing Address - Country:US
Mailing Address - Phone:631-586-3700
Mailing Address - Fax:631-586-3735
Practice Address - Street 1:2033 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2109
Practice Address - Country:US
Practice Address - Phone:631-586-3700
Practice Address - Fax:631-586-3735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204650208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1548312051OtherNPI
NY1184701674OtherNPI
NY1346248689OtherNPI