MEDICARE: PERLA TATE PHYSICIANS PLLC

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	207VG0400X	Gynecology Physician	148802	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427090174
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERLA TATE PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	80 GUY LOMBARDO AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3715
Country	:	US
Telephone Number	:	516-377-1023
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 GUY LOMBARDO AVE
Second Line	:
City	:	FREEPORT
State	:	NY
Zip	:	11520-3715
Country	:	US
Telephone Number	:	516-377-1023
Fax Number	:

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	DR. PERLA TATE
Credential	:	M.D.
Telephone Number	:	516-377-1023

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/22/2020

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