Provider Demographics
NPI:1033123153
Name:PERERA, SHARMALIE (MD)
Entity Type:Individual
Prefix:
First Name:SHARMALIE
Middle Name:
Last Name:PERERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1947 KENNEDY BLVD
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305
Mailing Address - Country:US
Mailing Address - Phone:201-433-4848
Mailing Address - Fax:201-946-9292
Practice Address - Street 1:1947 KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305
Practice Address - Country:US
Practice Address - Phone:201-433-4848
Practice Address - Fax:201-946-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68417174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7491603Medicaid
NJ7491506Medicaid
NJ558040Medicare ID - Type Unspecified
NJG21987Medicare UPIN
NJ7491506Medicaid