=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811573736
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWN PERISA PSYCHIATRY NP PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2021
-----------------------------------------------------
Last Update Date | 10/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 36 HARLEY AVE
-----------------------------------------------------
City | EAST NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11731-4911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-662-6161
-----------------------------------------------------
Fax | 631-266-4503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 36 HARLEY AVE
-----------------------------------------------------
City | EAST NORTHPORT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11731-4911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 374-556-0994
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DAWN J PERISA
-----------------------------------------------------
Credential | PMHNP-BC
-----------------------------------------------------
Telephone | 631-662-6161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------