1235312521 NPI number — DR MICHAEL PERLSTEIN

Table of content: (NPI 1235312521)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235312521 NPI number — DR MICHAEL PERLSTEIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR MICHAEL PERLSTEIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1235312521
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4414 14TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11219-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-438-8188
Provider Business Mailing Address Fax Number:
718-853-0169

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4414 14TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11219-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-438-8188
Provider Business Practice Location Address Fax Number:
718-853-0169
Provider Enumeration Date:
12/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERLSTEIN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-438-8188

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  N004124 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: N004124 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 103690101 . This is a "HEALTHPLUS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4471906-003 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: KS499 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P43031 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1499695 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P4303 . This is a "EMPIRE BLUECROSS BLUESHIE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 237111 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00966981 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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