Provider Demographics
NPI:1619914819
Name:PERIS, MARSHAL D (MD)
Entity Type:Individual
Prefix:
First Name:MARSHAL
Middle Name:D
Last Name:PERIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 S BEDFORD RD
Mailing Address - Street 2:CARE MOUNT MEDICAL, PC
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3446
Mailing Address - Country:US
Mailing Address - Phone:914-241-1050
Mailing Address - Fax:914-242-5685
Practice Address - Street 1:90 S BEDFORD RD
Practice Address - Street 2:CARE MOUNT MEDICAL, PC
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3412
Practice Address - Country:US
Practice Address - Phone:914-241-1050
Practice Address - Fax:914-242-5685
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2016-11-11
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Provider Licenses
StateLicense IDTaxonomies
NY224327207X00000X, 207XS0117X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02272113Medicaid
NY02272113Medicaid
NY465G906761Medicare PIN