Provider Demographics
NPI:1780702852
Name:MARTIN PERLIN, M.D.
Entity type:Organization
Organization Name:MARTIN PERLIN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-838-7205
Mailing Address - Street 1:118 N BEDFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-2555
Mailing Address - Country:US
Mailing Address - Phone:203-856-0185
Mailing Address - Fax:203-866-5594
Practice Address - Street 1:118 N BEDFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-2555
Practice Address - Country:US
Practice Address - Phone:203-856-0185
Practice Address - Fax:203-866-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030601207R00000X
NY131163261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306019Medicaid
NY00747484Medicaid
CT1306019Medicaid