MEDICARE: MR. ROGER PERRONE M.D.

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	207R00000X	Internal Medicine Physician	175975	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	W34601	OTHER	NY	GROUP UPIN

General Provider Information

NPI Number	:	1417905696
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGER PERRONE M.D.

Provider Business Mailing Address
First Line	:	1019 FORT SALONGA RD
Second Line	:	SUITE 101
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2270
Country	:	US
Telephone Number	:	631-262-1314
Fax Number	:	631-262-1328

Provider Business Practice Location Address
First Line	:	1019 FORT SALONGA RD
Second Line	:	SUITE 101
City	:	NORTHPORT
State	:	NY
Zip	:	11768-2270
Country	:	US
Telephone Number	:	631-262-1314
Fax Number	:	631-262-1328

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	08/13/2008

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