Provider Demographics
NPI:1174838130
Name:PERGAMENT, KATHLEEN MANGUNAY (DO, MPH)
Entity Type:Individual
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First Name:KATHLEEN
Middle Name:MANGUNAY
Last Name:PERGAMENT
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Gender:F
Credentials:DO, MPH
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Mailing Address - Street 1:185 SOUTH ORANGE MSB, ROOM I-506,
Mailing Address - Street 2:RUTGERS, NEW JERSEY MEDICAL SCHOOL, DEPT OF MEDICINE
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-5672
Mailing Address - Fax:
Practice Address - Street 1:90 BERGEN ST STE 4400
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103-2425
Practice Address - Country:US
Practice Address - Phone:973-972-1880
Practice Address - Fax:973-972-1879
Is Sole Proprietor?:No
Enumeration Date:2010-08-15
Last Update Date:2015-08-07
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY265560-1207R00000X
NJ25MB09641000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine