Provider Demographics
NPI:1184665135
Name:PERON, DIDIER L (MD)
Entity Type:Individual
Prefix:
First Name:DIDIER
Middle Name:L
Last Name:PERON
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 1:26 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7310
Mailing Address - Country:US
Mailing Address - Phone:973-267-1851
Mailing Address - Fax:973-267-0024
Practice Address - Street 1:26 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-7310
Practice Address - Country:US
Practice Address - Phone:973-267-1851
Practice Address - Fax:973-267-0024
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ066567BWWMedicare ID - Type Unspecified
NJF04934Medicare UPIN