Healthcare Provider Details

I. General information

NPI: 1972872901
Provider Name (Legal Business Name): EUGENE PERLOV MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2011
Last Update Date: 12/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 W BROADWAY
NEW YORK NY
10007-2170
US

IV. Provider business mailing address

133 W 17TH ST APT 5C
NEW YORK NY
10011-5448
US

V. Phone/Fax

Practice location:
  • Phone: 917-648-1913
  • Fax: 347-457-3199
Mailing address:
  • Phone: 718-787-3150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number236752
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number236752
License Number StateNY

VIII. Authorized Official

Name: EUGENE PERLOV
Title or Position: PRESIDENT
Credential: M.D.
Phone: 917-648-1913