Healthcare Provider Details

I. General information

NPI: 1467409813
Provider Name (Legal Business Name): KENNETH PERRINE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

525 E 68TH ST NEUROLOGICAL SURGERY, BOX 99
NEW YORK NY
10065-4870
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-2197
  • Fax: 212-746-8947
Mailing address:
  • Phone: 212-746-2197
  • Fax: 212-746-8947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number010408
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number010408
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: