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General NPI Number Information
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NPI Number | 1275135832
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Entity Type | Individual
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Provider Name | JAMES CHARLES PERREAULT PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/09/2020
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Last Update Date | 11/09/2020
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Provider Practice Location Address
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Address Line | ONE GUSTAVE L. LEVY PLACE
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City | NEW YORK
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State | NY
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Zip | 10029
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Country | US
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Telephone | 212-659-5600
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Fax |
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Provider Business Mailing Address
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Address Line | 351 E 82ND ST APT 2FE
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City | NEW YORK
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State | NY
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Zip | 10028-4164
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Country | US
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Telephone | 262-352-1574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 025884
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License Number State | NY
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