1669684908 NPI number — DR. IRINA PERELMAN O.D.

Table of content: DR. IRINA PERELMAN O.D. (NPI 1669684908)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669684908 NPI number — DR. IRINA PERELMAN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERELMAN
Provider First Name:
IRINA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PERELMAN-GRABOIS
Provider Other First Name:
IRINA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669684908
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 MAIN ST
Provider Second Line Business Mailing Address:
STE 104
Provider Business Mailing Address City Name:
HACKENSACK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07601-7130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-488-7119
Provider Business Mailing Address Fax Number:
201-525-5214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 MAIN ST
Provider Second Line Business Practice Location Address:
STE 104
Provider Business Practice Location Address City Name:
HACKENSACK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07601-7130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-488-7119
Provider Business Practice Location Address Fax Number:
201-525-5214
Provider Enumeration Date:
05/06/2007

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:  27OA00503300 , 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: 911671 . This is a "EYE MED PROVIDER NUMBER" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com