Provider Demographics
NPI:1841399862
Name:PERVIL, PAUL R (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:R
Last Name:PERVIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146A MANETTO HILL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1323
Mailing Address - Country:US
Mailing Address - Phone:516-822-4404
Mailing Address - Fax:
Practice Address - Street 1:146A MANETTO HILL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-1323
Practice Address - Country:US
Practice Address - Phone:516-822-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY132399207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11A401Medicare PIN