MEDICARE: NILES PERLAS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	239838	NY

General Provider Information

NPI Number	:	1235131715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NILES PERLAS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 27578
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10087-7578
Country	:	US
Telephone Number	:	888-877-3850
Fax Number	:	631-329-6951

Provider Business Practice Location Address
First Line	:	535 E 70TH ST
Second Line	:	HSS DEPT. OF ANESTHESIOLOGY
City	:	NEW YORK
State	:	NY
Zip	:	10021-4823
Country	:	US
Telephone Number	:	212-606-1206
Fax Number	:	212-517-4481

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	09/13/2012

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