1942311147 NPI number — DR. SANTUSHT A PERERA M.D.

Table of content: DR. SANTUSHT A PERERA M.D. (NPI 1942311147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942311147 NPI number — DR. SANTUSHT A PERERA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERERA
Provider First Name:
SANTUSHT
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1942311147
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
74 GREEN HILL RD
Provider Second Line Business Mailing Address:
74 GREENHILL ROAD
Provider Business Mailing Address City Name:
KINNELON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07405-2134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-838-6635
Provider Business Mailing Address Fax Number:
973-838-6637

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
142 PALISADE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY CITY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07306-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-982-2313
Provider Business Practice Location Address Fax Number:
973-838-6637
Provider Enumeration Date:
08/31/2006

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: 208G00000X , with the licence number:  MA66642 , 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: 91000888100 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: MA66642 . This is a "LICENSE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0N0781 . This is a "EMPIRE HEALTH CARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 7263601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104139 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 292723 . This is a "AMERIGROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: P1916232 . This is a "OXFORD HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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