MEDICARE: DR. RICHARD SALVATORE PERROTTO PH. 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	103T00000X	Psychologist	007076-1	NY

General Provider Information

NPI Number	:	1699760256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD SALVATORE PERROTTO PH. D.

Provider Business Mailing Address
First Line	:	4513 LITTLE NECK PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-1426
Country	:	US
Telephone Number	:	718-631-3805
Fax Number	:	845-735-6931

Provider Business Practice Location Address
First Line	:	4513 LITTLE NECK PKWY
Second Line	:
City	:	LITTLE NECK
State	:	NY
Zip	:	11362-1426
Country	:	US
Telephone Number	:	718-631-3805
Fax Number	:	845-735-6931

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

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	07/08/2007

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