Provider Demographics
NPI:1962724930
Name:PERRY, IAN
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:PERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 EAST 220TH STREET
Mailing Address - Street 2:APT 2J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5349
Mailing Address - Country:US
Mailing Address - Phone:646-321-3342
Mailing Address - Fax:
Practice Address - Street 1:624 E 220TH ST APT 2J
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-5349
Practice Address - Country:US
Practice Address - Phone:646-321-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK007549-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant