Provider Demographics
NPI:1124000930
Name:ROBERT J PERIN MD PA
Entity Type:Organization
Organization Name:ROBERT J PERIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:856-845-8300
Mailing Address - Street 1:630 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-3118
Mailing Address - Country:US
Mailing Address - Phone:856-845-8300
Mailing Address - Fax:856-845-2512
Practice Address - Street 1:630 SALEM AVE
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-3118
Practice Address - Country:US
Practice Address - Phone:856-845-8300
Practice Address - Fax:856-845-2512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37634207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ08233209Medicaid
NJ08233209Medicaid
C63298Medicare UPIN