Provider Demographics
NPI:1386689222
Name:DE PERALTA, MARIA TERESA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:MARIA TERESA
Middle Name:
Last Name:DE PERALTA
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351A NORTHFIELD LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-1794
Mailing Address - Country:US
Mailing Address - Phone:702-321-6459
Mailing Address - Fax:888-294-9371
Practice Address - Street 1:351A NORTHFIELD LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NJ
Practice Address - Zip Code:08831-1794
Practice Address - Country:US
Practice Address - Phone:702-321-6459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000928363LA2200X
NJ26NN09621900363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003565Medicaid
NJP8873Medicare UPIN
NJ0003565Medicaid