Provider Demographics
NPI:1669343984
Name:EAST GULF PARTNERS PA
Entity type:Organization
Organization Name:EAST GULF PARTNERS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:857-321-9357
Mailing Address - Street 1:955 MASSACHUSETTS AVE STE 158
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3180
Mailing Address - Country:US
Mailing Address - Phone:857-367-8074
Mailing Address - Fax:
Practice Address - Street 1:8 KINNAIRD ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3733
Practice Address - Country:US
Practice Address - Phone:857-367-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty