Provider Demographics
NPI:1780757666
Name:PERNA, DAVID THOMAS (DC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:THOMAS
Last Name:PERNA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 E 58TH STREET
Mailing Address - Street 2:SUITE 708
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-1236
Mailing Address - Country:US
Mailing Address - Phone:212-371-2000
Mailing Address - Fax:212-371-2250
Practice Address - Street 1:133 E 58TH STREET
Practice Address - Street 2:SUITE 708
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-1236
Practice Address - Country:US
Practice Address - Phone:212-371-2000
Practice Address - Fax:212-371-2250
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2009-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX010423-1111N00000X
NJ38MC00603300111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYXOHE81Medicare UPIN
NYXOHE81Medicare ID - Type UnspecifiedMEDICARE PROVIDER #