Individual provider Active NPI

Ruthann Perillo, MD

  • Internal Medicine Physician
  • Huntington Station, NY
National Provider Identifier
1528065562
Registry record updated Mar 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
207519-1 Issued in NY
Practice address
180 E Pulaski Rd
Huntington Station, NY 11746-1915
Phone
(631) 425-2121
Fax
(631) 425-2193
NPI assigned
Jul 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 207519-1 NY Primary

Addresses

Primary practice location

180 E Pulaski Rd
Huntington Station, NY 11746-1915

Mailing address

180 E Pulaski Rd
Huntington Station, NY 11746-1915
Phone (631) 425-2121

Other identifiers 1

IdentifierTypeStateIssuer
01944696MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rperillo104987@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101209000418 NY Practitioner - Internal Medicine 2264508316 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
207519-1NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New York University Internal Medicine CurrentSince Jun 1, 2015 Accepting new patients
New York University Internal Medicine CurrentSince Jun 1, 2015 Accepting new patients

Locations

180 Pulaski Rd
Huntington Station, NY 11746
Phone (631) 425-2121

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1528065562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 E PULASKI RD",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117461915",
            "telephone_number": "631-425-2121",
            "fax_number": "631-425-2193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "180 E PULASKI RD",
            "city": "HUNTINGTON STATION",
            "state": "NY",
            "postal_code": "117461915",
            "telephone_number": "631-425-2121",
            "fax_number": "631-425-2193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERILLO",
        "first_name": "RUTHANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "207519-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01944696",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rperillo104987@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "180 E Pulaski Rd",
            "city": "Huntington Station",
            "state": "NY",
            "country_code": "US",
            "postal_code": "117461915",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Huntington Station, NY

Sources for this page

Verify at the official NPI Registry.