Provider Demographics
NPI:1043302722
Name:RICHARD PERELMUT
Entity type:Organization
Organization Name:RICHARD PERELMUT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PERELMUT
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:315-472-0101
Mailing Address - Street 1:716 JAMES ST STE 103
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2087
Mailing Address - Country:US
Mailing Address - Phone:315-472-0101
Mailing Address - Fax:315-472-0190
Practice Address - Street 1:716 JAMES ST STE 103
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2087
Practice Address - Country:US
Practice Address - Phone:315-472-0101
Practice Address - Fax:315-472-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00553902Medicaid
NY0541100001Medicare NSC