MEDICARE: DR. ROY STURAT PERLES DPM

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	213E00000X	Podiatrist	NY003427	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0090904	OTHER	NY	GHI
2	DS599	OTHER	NV	OXFORD

General Provider Information

NPI Number	:	1659326817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROY STURAT PERLES DPM

Provider Business Mailing Address
First Line	:	22508 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411-1727
Country	:	US
Telephone Number	:	718-528-8558
Fax Number	:

Provider Business Practice Location Address
First Line	:	22508 LINDEN BLVD
Second Line	:
City	:	CAMBRIA HTS
State	:	NY
Zip	:	11411-1727
Country	:	US
Telephone Number	:	718-528-8558
Fax Number	:

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	11/13/2007

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