Provider Demographics
NPI:1598903718
Name:PERRONE, PAUL MICHAEL (RN)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MICHAEL
Last Name:PERRONE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 JACQUELINE CT
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3116
Mailing Address - Country:US
Mailing Address - Phone:631-236-3699
Mailing Address - Fax:
Practice Address - Street 1:1 JACQUELINE CT
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3116
Practice Address - Country:US
Practice Address - Phone:631-236-3699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-26
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY517867163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse