Provider Demographics
NPI:1811573736
Name:DAWN PERISA PSYCHIATRY NP PC
Entity Type:Organization
Organization Name:DAWN PERISA PSYCHIATRY NP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERISA
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:631-662-6161
Mailing Address - Street 1:36 HARLEY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-4911
Mailing Address - Country:US
Mailing Address - Phone:374-556-0994
Mailing Address - Fax:
Practice Address - Street 1:36 HARLEY AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-4911
Practice Address - Country:US
Practice Address - Phone:631-662-6161
Practice Address - Fax:631-266-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-22
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05137962Medicaid