MEDICARE: MR. JEFFREY MNI PERLES MSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	RO12941-1	NY

General Provider Information

NPI Number	:	1225029226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY MNI PERLES MSW

Provider Business Mailing Address
First Line	:	632 E 8TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-5906
Country	:	US
Telephone Number	:	718-871-1063
Fax Number	:

Provider Business Practice Location Address
First Line	:	FORT HAMILTON ARMY BASE
Second Line	:	BLDG #114 RM 1-19
City	:	BROOKLYN
State	:	NY
Zip	:	11252-6530
Country	:	US
Telephone Number	:	718-630-4915
Fax Number	:	718-630-4941

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

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	07/08/2007

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