MEDICARE: PERLA ANTONIO 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	208000000X	Pediatrics Physician	126400-1	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	:	1871556522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERLA ANTONIO M.D.

Provider Business Mailing Address
First Line	:	615 RIVERSIDE BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2121
Country	:	US
Telephone Number	:	516-571-7795
Fax Number	:

Provider Business Practice Location Address
First Line	:	615 RIVERSIDE BLVD
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-2121
Country	:	US
Telephone Number	:	516-571-7795
Fax Number	:

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

Provider Enumeration Date	:	04/11/2006
Last Update Date	:	04/10/2008

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Directions to “ PERLA ANTONIO M.D.” Practice Location

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