1396815239 NPI number — DR. GLORIA J PERNA D.C

Table of content: DR. GLORIA J PERNA D.C (NPI 1396815239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396815239 NPI number — DR. GLORIA J PERNA D.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERNA
Provider First Name:
GLORIA
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERNA
Provider Other First Name:
GLORIA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.C.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1396815239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1077 HWY 34
Provider Second Line Business Mailing Address:
B
Provider Business Mailing Address City Name:
ABERDEEN
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07747-2162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-290-2288
Provider Business Mailing Address Fax Number:
732-290-2660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1077 STATE ROUTE 34
Provider Second Line Business Practice Location Address:
B
Provider Business Practice Location Address City Name:
MATAWAN
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07747-2162
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-290-2288
Provider Business Practice Location Address Fax Number:
732-290-2660
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  38MC00419900 , 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: 45 2002 . This is a "USH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1039636 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P 789383 . This is a "OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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