Healthcare Provider Details

I. General information

NPI: 1073730594
Provider Name (Legal Business Name): EUGENE PERLOV M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 ELIZABETH ST
CHAPPAQUA NY
10514-2512
US

IV. Provider business mailing address

220 E 42ND ST FL 7
NEW YORK NY
10017-5835
US

V. Phone/Fax

Practice location:
  • Phone: 917-648-1913
  • Fax:
Mailing address:
  • Phone: 212-609-1920
  • Fax: 212-290-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number225611
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number225611
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: