Provider Demographics
NPI:1982911152
Name:PERIDO, MAUREEN MALLARI (PT)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:MALLARI
Last Name:PERIDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7148 260TH ST
Mailing Address - Street 2:1ST FL.
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1151
Mailing Address - Country:US
Mailing Address - Phone:917-330-0785
Mailing Address - Fax:
Practice Address - Street 1:7148 260TH ST
Practice Address - Street 2:1ST FL.
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1151
Practice Address - Country:US
Practice Address - Phone:917-330-0785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62-022253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist