Provider Demographics
NPI:1215360375
Name:JEFFREY PERRICCI
Entity Type:Organization
Organization Name:JEFFREY PERRICCI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRICCI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:201-991-1733
Mailing Address - Street 1:594 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-2812
Mailing Address - Country:US
Mailing Address - Phone:201-991-1733
Mailing Address - Fax:201-991-3199
Practice Address - Street 1:594 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-2812
Practice Address - Country:US
Practice Address - Phone:201-991-1733
Practice Address - Fax:201-991-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental