1083622088 NPI number — STEVEN L PERRICK MD

Table of content: STEVEN L PERRICK MD (NPI 1083622088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083622088 NPI number — STEVEN L PERRICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRICK
Provider First Name:
STEVEN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083622088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
530 OLD COUNTRY ROAD
Provider Second Line Business Mailing Address:
STE 1B
Provider Business Mailing Address City Name:
WESTBURY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-333-7272
Provider Business Mailing Address Fax Number:
516-333-2519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
530 OLD COUNTRY ROAD
Provider Second Line Business Practice Location Address:
STE 1B
Provider Business Practice Location Address City Name:
WESTBURY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
516-333-7272
Provider Business Practice Location Address Fax Number:
516-333-2519
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  NY152412 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010152412 . This is a "ANTHEM" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1000015358 . This is a "AFFINITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9786625002 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0780SP . This is a "PRIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 30128460 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3C6478 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 93594 . This is a "VYTRA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P1280410 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 152412A27 . This is a "HEALTHFIRST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 771484 . This is a "HERITAGE ADVANTAGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000055633 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 176215315530830 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2154018 . This is a "USH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393479 . This is a "UH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7895093 . This is a "HIP" identifier . This identifiers is of the category "OTHER".
  • Identifier: AA50765 . This is a "NDNY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 91A751 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3627 . This is a "PIN" identifier . This identifiers is of the category "OTHER".




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