MEDICARE: DR. JOSEPH PERINO

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	103TC0700X	Clinical Psychologist	004608	NY

General Provider Information

NPI Number	:	1619907573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH PERINO

Provider Business Mailing Address
First Line	:	PO BOX 120
Second Line	:
City	:	EAST SETAUKET
State	:	NY
Zip	:	11733-0120
Country	:	US
Telephone Number	:	631-689-9424
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 UNION AVE
Second Line	:	STE. 101
City	:	HOLBROOK
State	:	NY
Zip	:	11741-1820
Country	:	US
Telephone Number	:	631-689-9424
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. JOSEPH PERINO ” Practice Location

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