Healthcare Provider Details

I. General information

NPI: 1619899465
Provider Name (Legal Business Name): KURT PERINE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MADISON STREET 17 -I
NEW YORK NY
10002
US

IV. Provider business mailing address

160 MADISON STREET 17 -I
NEW YORK NY
10002
US

V. Phone/Fax

Practice location:
  • Phone: 646-585-6141
  • Fax: 646-585-1641
Mailing address:
  • Phone:
  • Fax: 646-585-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number401501432
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: