MEDICARE: KIM PERRETTA APN-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	26NJ00090500	NJ

General Provider Information

NPI Number	:	1215197272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM PERRETTA APN-C

Provider Business Mailing Address
First Line	:	62 COVENTRY WAY
Second Line	:
City	:	RINGWOOD
State	:	NJ
Zip	:	07456-2748
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 64TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-4745
Country	:	US
Telephone Number	:	917-974-0479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2008
Last Update Date	:	02/16/2024

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