Healthcare Provider Details

I. General information

NPI: 1356093900
Provider Name (Legal Business Name): ALEXANDER PERISSI PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2022
Last Update Date: 01/25/2022
Certification Date: 01/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

467 NEW YORK AVE
HUNTINGTON NY
11743-3557
US

IV. Provider business mailing address

467 NEW YORK AVE
HUNTINGTON NY
11743-3557
US

V. Phone/Fax

Practice location:
  • Phone: 631-424-1100
  • Fax: 888-483-0941
Mailing address:
  • Phone: 631-424-1100
  • Fax: 888-483-0941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number048227-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: