Provider Demographics
NPI:1710399985
Name:PERELMAN, ALEXANDER (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:PERELMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 BROADWAY
Mailing Address - Street 2:SUITE 2750
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10279
Mailing Address - Country:US
Mailing Address - Phone:646-971-0237
Mailing Address - Fax:
Practice Address - Street 1:233 BROADWAY
Practice Address - Street 2:SUITE 2750
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10279
Practice Address - Country:US
Practice Address - Phone:646-971-0237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-22
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY301802-01207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty