MEDICARE: CAROL PERRINI LLC

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	174H00000X	Health Educator

General Provider Information

NPI Number	:	1942562343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROL PERRINI LLC

Provider Business Mailing Address
First Line	:	3-31 BEACH 149 STREET
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11694
Country	:	US
Telephone Number	:	646-642-7226
Fax Number	:	718-945-3979

Provider Business Practice Location Address
First Line	:	331 BEACH 149TH ST
Second Line	:
City	:	FAR ROCKAWAY
State	:	NY
Zip	:	11694-1026
Country	:	US
Telephone Number	:	646-642-7226
Fax Number	:	718-945-3979

Authorized Official
Title or Position	:	SOLE PROPRIETORSHIP
Name	:	CAROL PERRINI
Credential	:	M.S.ED
Telephone Number	:	646-642-7226

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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