Provider Demographics
NPI:1851680656
Name:PERLL DIAGNOSTICS INC
Entity Type:Organization
Organization Name:PERLL DIAGNOSTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:FERYAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NAWAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-394-2776
Mailing Address - Street 1:5010 RITTER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4828
Mailing Address - Country:US
Mailing Address - Phone:717-691-1500
Mailing Address - Fax:717-691-5551
Practice Address - Street 1:5010 RITTER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055
Practice Address - Country:US
Practice Address - Phone:717-691-1500
Practice Address - Fax:717-691-5551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102599817-0001Medicaid
PA102599817-0002Medicaid
PA102599817-0001Medicaid