=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861867095
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONTEMPORARY TMS OF MANHASSETT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/14/2015
-----------------------------------------------------
Last Update Date | 05/13/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1165 NORTHERN BLVD SUITE 200
-----------------------------------------------------
City | MANHASSET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11030-3039
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-482-0667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 81 HOLLY HILL LN 2ND FLOOR
-----------------------------------------------------
City | GREENWICH
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06830-6071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-482-0667
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TARIQUE PERERA
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 203-482-0667
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 305S00000X
-----------------------------------------------------
Taxonomy Name | Point of Service
-----------------------------------------------------
License Number | 039232
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------