Provider Demographics
NPI:1881750149
Name:PERRY, HERBERT S (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:S
Last Name:PERRY
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 1:65 DOSORIS WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542-2617
Mailing Address - Country:US
Mailing Address - Phone:516-676-3111
Mailing Address - Fax:516-671-2757
Practice Address - Street 1:65 DOSORIS WAY
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2617
Practice Address - Country:US
Practice Address - Phone:516-676-3111
Practice Address - Fax:516-671-2757
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00149995Medicaid
NYC11384Medicare UPIN
NY560811Medicare ID - Type Unspecified