Provider Demographics
NPI:1740345313
Name:PERLMUTTER, STEPHEN (DPM)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:
Last Name:PERLMUTTER
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 1:535 SAYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-4743
Mailing Address - Country:US
Mailing Address - Phone:860-346-5226
Mailing Address - Fax:860-347-6280
Practice Address - Street 1:535 SAYBROOK RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4743
Practice Address - Country:US
Practice Address - Phone:860-346-5226
Practice Address - Fax:860-347-6280
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00140213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22765Medicare UPIN