Provider Demographics
NPI:1801825310
Name:PERDUE, ROBERT (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PERDUE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:500 W MAIN ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3027
Mailing Address - Country:US
Mailing Address - Phone:631-422-6166
Mailing Address - Fax:631-422-6269
Practice Address - Street 1:500 W MAIN ST
Practice Address - Street 2:SUITE 116
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3027
Practice Address - Country:US
Practice Address - Phone:631-422-6166
Practice Address - Fax:631-422-6269
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2013-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY004354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5235L1Medicare PIN