Basic Information
Provider Information
NPI: 1023534856
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERLMAN
FirstName: STEPHANIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 35 E 35TH ST APT 12E
Address2:  
City: NEW YORK
State: NY
PostalCode: 100163826
CountryCode: US
TelephoneNumber: 3057989112
FaxNumber:  
Practice Location
Address1: 600 E 233RD ST
Address2:  
City: BRONX
State: NY
PostalCode: 104662604
CountryCode: US
TelephoneNumber: 7189209000
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/14/2017
LastUpdateDate: 08/14/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X021149NYY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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