Healthcare Provider Details

I. General information

NPI: 1154768711
Provider Name (Legal Business Name): MS. HAYLEY PERELMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 AMERICAN LEGION HWY
ROSLINDALE MA
02131-3908
US

IV. Provider business mailing address

69 PARK DR APT 17
BOSTON MA
02215-5236
US

V. Phone/Fax

Practice location:
  • Phone: 617-254-0964
  • Fax:
Mailing address:
  • Phone: 914-330-7716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: