Healthcare Provider Details

I. General information

NPI: 1275467987
Provider Name (Legal Business Name): EVAN ANTHONY PERONE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 WOOD ST
BETHLEHEM PA
18018-4453
US

IV. Provider business mailing address

3 WEBSTER ST
EAST BANGOR PA
18013-2147
US

V. Phone/Fax

Practice location:
  • Phone: 610-625-4885
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License NumberTOP009441
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: