Healthcare Provider Details

I. General information

NPI: 1669343984
Provider Name (Legal Business Name): EAST GULF PARTNERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2025
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 KINNAIRD ST
CAMBRIDGE MA
02139-3733
US

IV. Provider business mailing address

955 MASSACHUSETTS AVE STE 158
CAMBRIDGE MA
02139-3180
US

V. Phone/Fax

Practice location:
  • Phone: 857-367-8074
  • Fax:
Mailing address:
  • Phone: 857-367-8074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name: ROY PERLIS
Title or Position: PRESIDENT
Credential: MD
Phone: 857-321-9357