Provider Demographics
NPI:1790924942
Name:PERLBERG, ROBIN (LAC)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:PERLBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 VANDERVENTER AVE
Mailing Address - Street 2:SUITE 145
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-3737
Mailing Address - Country:US
Mailing Address - Phone:516-316-7832
Mailing Address - Fax:516-708-9791
Practice Address - Street 1:14 VANDERVENTER AVE
Practice Address - Street 2:SUITE 145
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-3737
Practice Address - Country:US
Practice Address - Phone:516-316-7821
Practice Address - Fax:516-708-9791
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001319171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2640741OtherOXFORD HEALTH PLANS