Provider Demographics
NPI:1699514018
Name:IHIANLE-PERLMAN, IMADE
Entity type:Individual
Prefix:
First Name:IMADE
Middle Name:
Last Name:IHIANLE-PERLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 W FORT LEE RD APT 4303
Mailing Address - Street 2:
Mailing Address - City:BOGOTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07603-1562
Mailing Address - Country:US
Mailing Address - Phone:312-912-5450
Mailing Address - Fax:
Practice Address - Street 1:155 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-2213
Practice Address - Country:US
Practice Address - Phone:312-912-5450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY60-P128296-01207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty