Provider Demographics
NPI:1235350968
Name:PERMAN, KRISTEN G (LAC, CA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:G
Last Name:PERMAN
Suffix:
Gender:F
Credentials:LAC, CA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MORRIS AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1506
Mailing Address - Country:US
Mailing Address - Phone:908-277-1007
Mailing Address - Fax:
Practice Address - Street 1:510 MORRIS AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-1506
Practice Address - Country:US
Practice Address - Phone:908-277-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00036300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist