Active NPI
Anthony Perugini
- Dentist
- Staten Island, NY
National Provider Identifier
1124048137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 040243
- Practice address
- 4787 Hylan Blvd
Staten Island, NY 10312-6360 - Phone
- (718) 967-1112
- Fax
- (718) 948-1290
- NPI assigned
- Jul 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 040243 | NY | Primary |
Addresses
Primary practice location
4787 Hylan Blvd
Staten Island, NY 10312-6360
Mailing address
4787 Hylan Blvd
Staten Island, NY 10312-6360
Phone (718) 967-1112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 29, 2015 through Jun 29, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 040243 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124048137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4787 HYLAN BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103126360",
"telephone_number": "718-967-1112",
"fax_number": "718-948-1290"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4787 HYLAN BLVD",
"city": "STATEN ISLAND",
"state": "NY",
"postal_code": "103126360",
"telephone_number": "718-967-1112",
"fax_number": "718-948-1290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERUGINI",
"first_name": "ANTHONY",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "040243",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Staten Island, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.