Healthcare Provider Details

I. General information

NPI: 1083172340
Provider Name (Legal Business Name): ALICIA PERRIGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 6TH ST
MALONE NY
12953-1246
US

IV. Provider business mailing address

986 WEST MAIN STREET
BURKE NY
12917
US

V. Phone/Fax

Practice location:
  • Phone: 518-481-5746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: