1467409409 NPI number — DR. ADAM JAY PERLIN OD

Table of content: DR. ADAM JAY PERLIN OD (NPI 1467409409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467409409 NPI number — DR. ADAM JAY PERLIN OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERLIN
Provider First Name:
ADAM
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1467409409
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 GYPSY LN
Provider Second Line Business Mailing Address:
UNIT 548
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19129-5460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-432-4048
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1192 WHITE HORSE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VOORHEES
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08043-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
856-428-0100
Provider Business Practice Location Address Fax Number:
856-428-6788
Provider Enumeration Date:
05/27/2006

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: 152W00000X , with the licence number:  27OA00541200 , 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: 7855508 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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