Provider Demographics
NPI:1346334067
Name:PERALTA, ADELA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ADELA
Middle Name:M
Last Name:PERALTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 KEARNY AVE
Mailing Address - Street 2:1RST FLOOR
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032
Mailing Address - Country:US
Mailing Address - Phone:201-997-8494
Mailing Address - Fax:201-997-7100
Practice Address - Street 1:714 KEARNY AVE
Practice Address - Street 2:1RST FLOOR
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032
Practice Address - Country:US
Practice Address - Phone:201-997-8494
Practice Address - Fax:201-997-7100
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03733600174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP713210OtherOXFORD
NJ22906OtherAMERIGROUP
NJ5467600OtherAETNA HMO
NJ1K3493OtherHEALTHNET
NJ2491800Medicaid
NJ3022452-008OtherCIGNA
NJ5467600OtherAETNA NON HMO
NJ1098257OtherHORIZON NJ
NJ2215613OtherAETNA/USHC
NJ10963OtherUNIVERSITY HEALTH PLAN
NJ293248OtherUNITED HEALTH CARE
NJ293248OtherUNITED HEALTH CARE
NJ5467600OtherAETNA NON HMO