MEDICARE: DR. PERLA TATE M.D.

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	:	1578501698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERLA TATE M.D.

Provider Business Mailing Address
First Line	:	1624 CENTRAL AVE
Second Line	:	MEZZANINE
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4002
Country	:	US
Telephone Number	:	718-327-7969
Fax Number	:	718-327-8463

Provider Business Practice Location Address
First Line	:	1624 CENTRAL AVE
Second Line	:	MEZZANINE
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11691-4002
Country	:	US
Telephone Number	:	718-327-7969
Fax Number	:	718-327-8463

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

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/30/2010

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