Basic Information
| Provider Information | |||||||||
| NPI: | 1942203724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PERLSTEIN | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 W 98TH ST | ||||||||
| Address2: | APT 5E | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100255633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609071 | ||||||||
| FaxNumber: | 7189603792 | ||||||||
| Practice Location | |||||||||
| Address1: | 4422 3RD AVE | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104572545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189609071 | ||||||||
| FaxNumber: | 7189603792 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 203473 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 1909508 | 05 | NY | MEDICAID | 9T1911 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER |