Healthcare Provider Details

I. General information

NPI: 1083280887
Provider Name (Legal Business Name): EVANGELIA PERRONE CPHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK AVE S STE 87234
NEW YORK NY
10003-1502
US

IV. Provider business mailing address

55 HIGHLAWN AVE
BROOKLYN NY
11223-2402
US

V. Phone/Fax

Practice location:
  • Phone: 646-844-6142
  • Fax: 833-434-0563
Mailing address:
  • Phone: 347-738-2234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number30129673
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: