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NPI Code Detail

MEDICARE: ROBERT PERDUE P.A.

MEDICARE: ROBERT PERDUE P.A.
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
1363A00000XPhysician Assistant004354NY

General Provider Information

NPI Number : 1801825310
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT PERDUE P.A.
Provider Business Mailing Address
First Line : 500 W MAIN ST
Second Line : SUITE 116
City : BABYLON
State : NY
Zip : 11702-3027
Country : US
Telephone Number : 631-422-6166
Fax Number : 631-422-6269
Provider Business Practice Location Address
First Line : 500 W MAIN ST
Second Line : SUITE 116
City : BABYLON
State : NY
Zip : 11702-3027
Country : US
Telephone Number : 631-422-6166
Fax Number : 631-422-6269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2006
Last Update Date : 09/27/2013

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