Provider Demographics
NPI:1093703142
Name:PERKEL, JASON MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:MARK
Last Name:PERKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:487 MILTON RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:CT
Mailing Address - Zip Code:06756-1611
Mailing Address - Country:US
Mailing Address - Phone:860-491-1012
Mailing Address - Fax:
Practice Address - Street 1:538 LITCHFIELD ST
Practice Address - Street 2:SUITE G-02
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6669
Practice Address - Country:US
Practice Address - Phone:860-489-5068
Practice Address - Fax:860-489-3725
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037971208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001379719Medicaid