Provider Demographics
NPI:1891860128
Name:PERILLO, FRANK B (DPM)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:B
Last Name:PERILLO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 HERTEL AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2826
Mailing Address - Country:US
Mailing Address - Phone:716-838-1131
Mailing Address - Fax:716-838-1158
Practice Address - Street 1:1431 HERTEL AVE
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14216-2826
Practice Address - Country:US
Practice Address - Phone:716-838-1131
Practice Address - Fax:716-838-1158
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY002894213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBLUE CROSSOther000508117001
NYUNITED HEALTHCAREOther2700260
NYFIDELISOther040426000209
NY161304145OtherTAX ID
NYBLUE CROSS DMEOther000508117004
NYC10060OtherRAILROAD MEDICARE GROUP #
NYINDEPENDENT HEALTHOther8990091
NY480003114OtherRAILROAD MEDICARE PROVIDER #
NY00668997Medicaid
NYGHIOther6008087
NYUNIVERAOther00010256201
NYINDEPENDENT HEALTHOther8990091
NYT88396Medicare UPIN
NY00668997Medicaid