Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 048227-1 | NY |
Y | 213ES0000X | Sports Medicine | 048227-1 | NY |
NPI | 1356093900 |
---|---|
Provider Name | Alexander Perissi |
First Address | Huntington, NY 11743-3557 |
Second Address | Huntington, NY 11743-3557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2022 |
Last Update Date | 25/01/2022 |