Individual
MRS. MARILOU MIRA OMOYON-PERHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 BELLE TERRE RD, INTENSIVE CARE NURSERY, PORT JEFFERSON, NY 11777-1928
(631) 474-6577
(631) 474-6356
Mailing address
PO BOX 272, ISLAND NEONATOLOGY PLLC, EAST ISLIP, NY 11730-0272
(631) 224-1878
(631) 224-7963
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
F350156-1
NY
Other
Enumeration date
01/19/2007
Last updated
07/08/2007
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