Provider Demographics
NPI:1780726513
Name:PERLMAN, MARY ANN (NP)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:PERLMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RUDPOLPH RD
Mailing Address - Street 2:SUNY OSWEGO
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126
Mailing Address - Country:US
Mailing Address - Phone:315-342-7862
Mailing Address - Fax:315-343-5317
Practice Address - Street 1:1 RUDOLPH RD
Practice Address - Street 2:SUNY OSWEGO
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126
Practice Address - Country:US
Practice Address - Phone:315-342-2024
Practice Address - Fax:315-343-5317
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331173-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS24896Medicare UPIN
NYDD6600Medicare ID - Type Unspecified