Provider Demographics
NPI:1801874250
Name:PERI, JAMES R (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:PERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2882 W 15TH ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-2770
Mailing Address - Country:US
Mailing Address - Phone:718-837-0010
Mailing Address - Fax:718-837-1411
Practice Address - Street 1:2882 W 15TH ST
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-2770
Practice Address - Country:US
Practice Address - Phone:718-837-0010
Practice Address - Fax:718-837-1411
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145511-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00595304Medicaid
NY00595304Medicaid
NYA400025611Medicare PIN