Provider Demographics
NPI:1932404696
Name:PERLIN, DIANA
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:PERLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ANNETTE WAY
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2835
Mailing Address - Country:US
Mailing Address - Phone:718-810-9505
Mailing Address - Fax:
Practice Address - Street 1:33 ANNETTE WAY
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2835
Practice Address - Country:US
Practice Address - Phone:718-810-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency