MEDICARE: EUGENE PERLOV MD PC

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	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	236752	NY
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	236752	NY

General Provider Information

NPI Number	:	1972872901
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUGENE PERLOV MD PC

Provider Business Mailing Address
First Line	:	133 W 17TH ST
Second Line	:	APT 5C
City	:	NEW YORK
State	:	NY
Zip	:	10011-5448
Country	:	US
Telephone Number	:	718-787-3150
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 W BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10007-2170
Country	:	US
Telephone Number	:	917-648-1913
Fax Number	:	347-457-3199

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUGENE PERLOV
Credential	:	M.D.
Telephone Number	:	917-648-1913

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	12/21/2011

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