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General NPI Number Information
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NPI Number | 1942329107
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Entity Type | Organization
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Legal Business Name | PERSAUD MEDICAL, PLLC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 150 BROADHOLLOW RD SUITE 311
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City | MELVILLE
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State | NY
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Zip | 11747-4905
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Country | US
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Telephone | 631-470-7915
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Fax | 631-470-7922
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Provider Business Mailing Address
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Address Line | 150 BROADHOLLOW RD SUITE 311
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City | MELVILLE
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State | NY
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Zip | 11747-4905
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Country | US
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Telephone | 631-470-7915
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Fax | 631-470-7922
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Authorized Official
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Title or Position | OWNER
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Name | ARETHA PERSAUD
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Credential | MD
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Telephone | 631-470-7915
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 228552
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License Number State | NY
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