Provider Demographics
NPI:1356408025
Name:PERINO, JOSEPH GERALD (PHD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GERALD
Last Name:PERINO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 ISLIP AVE
Mailing Address - Street 2:
Mailing Address - City:ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11751-1809
Mailing Address - Country:US
Mailing Address - Phone:631-277-8618
Mailing Address - Fax:631-277-8660
Practice Address - Street 1:499 ISLIP AVE
Practice Address - Street 2:
Practice Address - City:ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11751-1809
Practice Address - Country:US
Practice Address - Phone:631-277-8618
Practice Address - Fax:631-277-8660
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009-003103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01030331Medicaid
NYV64031Medicare ID - Type Unspecified