Provider Demographics
NPI:1184121642
Name:PERAFAN, KATHRYN (MSED)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:PERAFAN
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3428
Mailing Address - Country:US
Mailing Address - Phone:516-476-4381
Mailing Address - Fax:
Practice Address - Street 1:69 SMITH ST
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3428
Practice Address - Country:US
Practice Address - Phone:516-476-4381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2662833174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist