Provider Demographics
NPI:1609829761
Name:PERSHEFF, NADINE (MD)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:
Last Name:PERSHEFF
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 1:444 N SEA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-2057
Mailing Address - Country:US
Mailing Address - Phone:631-283-4843
Mailing Address - Fax:631-259-3850
Practice Address - Street 1:444 N SEA RD
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-2057
Practice Address - Country:US
Practice Address - Phone:631-283-4843
Practice Address - Fax:631-614-7969
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2063562080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01901757Medicaid