Provider Demographics
NPI:1396815239
Name:PERNA, GLORIA J (DC)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:J
Last Name:PERNA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:J
Other - Last Name:PERNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1077 HWY 34
Mailing Address - Street 2:B
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-2162
Mailing Address - Country:US
Mailing Address - Phone:732-290-2288
Mailing Address - Fax:732-290-2660
Practice Address - Street 1:1077 STATE ROUTE 34
Practice Address - Street 2:B
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-2162
Practice Address - Country:US
Practice Address - Phone:732-290-2288
Practice Address - Fax:732-290-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00419900111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ45 2002OtherUSH
NJ1039636OtherAMERICAN SPECIALTY HEALTH
NJP 789383OtherOXFORD
NJ45 2002OtherUSH
NJPE 753867Medicare ID - Type Unspecified