Provider Demographics
NPI:1538186267
Name:PERAZZO, LUCY M (MD)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:M
Last Name:PERAZZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10532
Mailing Address - Country:US
Mailing Address - Phone:914-232-3135
Mailing Address - Fax:914-232-4465
Practice Address - Street 1:111 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10532
Practice Address - Country:US
Practice Address - Phone:914-232-3135
Practice Address - Fax:914-232-4465
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY209195207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02793539Medicaid
NY02793539Medicaid
NY18S7806761Medicare PIN