Provider Demographics
NPI:1164574455
Name:PERILLO, DONNA (DC)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:
Last Name:PERILLO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ARNOT ST
Mailing Address - Street 2:STE 3
Mailing Address - City:LODI
Mailing Address - State:NJ
Mailing Address - Zip Code:07644-1629
Mailing Address - Country:US
Mailing Address - Phone:973-472-5433
Mailing Address - Fax:973-473-6833
Practice Address - Street 1:2 ARNOT ST
Practice Address - Street 2:STE 3
Practice Address - City:LODI
Practice Address - State:NJ
Practice Address - Zip Code:07644-1629
Practice Address - Country:US
Practice Address - Phone:973-472-5433
Practice Address - Fax:973-473-6833
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC03737111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ585091PNWMedicare ID - Type Unspecified
NJT92052Medicare UPIN
NJ045562Medicare ID - Type Unspecified