Provider Demographics
NPI:1881702272
Name:PERRONE, STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:PERRONE
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 1:6855 FRESH POND RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11385-5263
Mailing Address - Country:US
Mailing Address - Phone:718-417-6565
Mailing Address - Fax:718-381-8840
Practice Address - Street 1:6855 FRESH POND RD
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NY
Practice Address - Zip Code:11385-5263
Practice Address - Country:US
Practice Address - Phone:718-417-6565
Practice Address - Fax:718-381-8840
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-27
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151616207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1881702272Medicaid
NY1881702272Medicaid
NYG400007919Medicare PIN
NY79393Medicare PIN
NYG100007918Medicare PIN
NY35D171Medicare PIN