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1780672717

NPI Code Detail

MEDICARE: ROBERT PERELLO MD

MEDICARE: ROBERT PERELLO MD

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	208000000X	Pediatrics Physician	ME68149	FL
2	208000000X	Pediatrics Physician	185997	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780672717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PERELLO MD

Provider Business Mailing Address
First Line	:	3332 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-8732
Country	:	US
Telephone Number	:	212-694-2000
Fax Number	:	212-281-4296

Provider Business Practice Location Address
First Line	:	3332 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-8732
Country	:	US
Telephone Number	:	212-694-2000
Fax Number	:	212-281-4296

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

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	12/14/2012

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Directions to “ ROBERT PERELLO MD” Practice Location

Language	Start Address	Practice Location

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