Healthcare Provider Details

I. General information

NPI: 1811335052
Provider Name (Legal Business Name): BROOKLYN PEDIATRIC INFECTIOUS DISEASED PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 74TH STREET
BROOKLYN NY
11209
US

IV. Provider business mailing address

433 74TH STREET
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-833-7600
  • Fax: 718-833-0302
Mailing address:
  • Phone: 718-833-7600
  • Fax: 718-833-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JASON E PERLMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 718-833-7600