Provider Demographics
NPI:1184884462
Name:PERILLO, JANE MARIE (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:MARIE
Last Name:PERILLO
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Gender:F
Credentials:CPNP
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Mailing Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Mailing Address - Street 2:HSCT11 031
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-8111
Mailing Address - Country:US
Mailing Address - Phone:631-444-1313
Mailing Address - Fax:631-444-7248
Practice Address - Street 1:STONY BROOK UNIVERSITY MEDICAL CENTER
Practice Address - Street 2:HSCT11 031
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-8111
Practice Address - Country:US
Practice Address - Phone:631-444-1313
Practice Address - Fax:631-444-7248
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
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Provider Licenses
StateLicense IDTaxonomies
NYF381632 1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics