Provider Demographics
NPI:1942220223
Name:PERRY, JOHN S (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:S
Last Name:PERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 HOOPER RD
Mailing Address - Street 2:
Mailing Address - City:ENDWELL
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3648
Mailing Address - Country:US
Mailing Address - Phone:607-754-3863
Mailing Address - Fax:607-754-5697
Practice Address - Street 1:415 HOOPER RD
Practice Address - Street 2:ENDWELL FAMILY PHYSICIANS LLP
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-3648
Practice Address - Country:US
Practice Address - Phone:607-754-3863
Practice Address - Fax:607-754-5697
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
80568957OtherHMO BLUE
10031703OtherCDPHP
80568957OtherEMPIRE BS
88414OtherMVP SELECT
4210341OtherAETNA
80568957OtherEXCELLUS
88414OtherMVP
NY0043885OtherCHAMPUS
4210341OtherAETNA HMO
NY01045812Medicaid
80568957OtherBS CNY
80568957OtherBLUEPOINT
9526384OtherGHI
88414OtherMVP
NY01045812Medicaid