Basic Information
Provider Information
NPI: 1174840771
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PERRETTA
FirstName: DONATO
MiddleName: JOSEPH
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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OtherCredential:  
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Mailing Information
Address1: 110 S BEDFORD RD
Address2:  
City: MOUNT KISCO
State: NY
PostalCode: 105493446
CountryCode: US
TelephoneNumber: 9142411050
FaxNumber: 9142421516
Practice Location
Address1: 1978 CROMPOND RD
Address2:  
City: CORTLANDT MANOR
State: NY
PostalCode: 105674111
CountryCode: US
TelephoneNumber: 9142411050
FaxNumber: 9147392185
Other Information
ProviderEnumerationDate: 04/23/2010
LastUpdateDate: 10/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X274027-1NYN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XS0106X274027-1NYY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
207X00000X262284MAN Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 
207XS0106X262284MAN Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery

No ID Information.


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