Healthcare Provider Details

I. General information

NPI: 1972505238
Provider Name (Legal Business Name): MICHAEL PERLSTEIN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 AVENUE L BSMT
BROOKLYN NY
11230-5002
US

IV. Provider business mailing address

1911 AVENUE L BSMT
BROOKLYN NY
11230-5002
US

V. Phone/Fax

Practice location:
  • Phone: 718-438-8188
  • Fax: 718-853-0169
Mailing address:
  • Phone: 718-438-8188
  • Fax: 718-853-0169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberN004124
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberN004124
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: