Provider Demographics
NPI:1598985418
Name:PERLOVA, MARINA (MD)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:PERLOVA
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 1:2327 - 83RD STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214
Mailing Address - Country:US
Mailing Address - Phone:718-265-3003
Mailing Address - Fax:718-265-1807
Practice Address - Street 1:6317 4TH AVE
Practice Address - Street 2:PARK RIDGE FAMILY HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-4922
Practice Address - Country:US
Practice Address - Phone:718-907-8100
Practice Address - Fax:718-492-8614
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01669323Medicaid
NYG36010Medicare UPIN
NY01669323Medicaid