Provider Demographics
NPI:1780602003
Name:PERONE, ROBERT W (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:PERONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7 BOND ST
Mailing Address - Street 2:LOFT 2D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2311
Mailing Address - Country:US
Mailing Address - Phone:212-604-8743
Mailing Address - Fax:212-604-2458
Practice Address - Street 1:7 BOND ST
Practice Address - Street 2:LOFT 2D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-2311
Practice Address - Country:US
Practice Address - Phone:212-604-8743
Practice Address - Fax:212-604-2458
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154824-12085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01120790Medicaid
NYE44822Medicare UPIN
NY43F261Medicare ID - Type Unspecified