Provider Demographics
NPI:1346324084
Name:PEREZ, RUBEN (MD)
Entity Type:Individual
Prefix:MR
First Name:RUBEN
Middle Name:
Last Name:PEREZ
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:P.O. BOX 831
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07087-0831
Mailing Address - Country:US
Mailing Address - Phone:201-866-2223
Mailing Address - Fax:201-866-0449
Practice Address - Street 1:525 42ND STREET
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:NJ
Practice Address - Zip Code:07087-0831
Practice Address - Country:US
Practice Address - Phone:201-866-2223
Practice Address - Fax:201-866-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07607300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003794Medicaid
NJ071911Medicare ID - Type Unspecified
NJH90657Medicare UPIN