1467414128 NPI number — WALTER PEREZ, M.D., L.L.C.

Table of content: (NPI 1467414128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467414128 NPI number — WALTER PEREZ, M.D., L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTER PEREZ, M.D., L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WALTER PEREZ, M.D LLC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467414128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 213
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARRISON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07029-0213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-350-0800
Provider Business Mailing Address Fax Number:
973-350-0885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
213 HARRISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRISON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07029-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-350-0800
Provider Business Practice Location Address Fax Number:
973-350-0885
Provider Enumeration Date:
04/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PEREZ
Authorized Official First Name:
INES
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
973-868-6597

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6953243 . This is a "CIGNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P3564059 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01000748501 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 34730 . This is a "UNIVERSITY HEALTH PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2143265 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2412577000 . This is a "AMERIHEALTH PPO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2412577001 . This is a "AMERIHEALTH HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 8223205 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2K7705 . This is a "HEALTH NET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 60013238 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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